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8/13/2019 Preterm Labor and Preterm Contractions
1/9
Preterm Labor and Preterm Contractions
Mounira Habli MD
Helen How MD
BasicsDescription
PTL:
o Labor resulting in birth before 37 wees gestation !"H#$
o %re&uent contractions !'()*+hr$ in presence of cer,ical change
!effacement- dilation$
.pontaneous PTL !7/0$:
o 1arl2 PTL before 3 wees gestation
o Later PTL after 3 wees gestation
4ndicated PTL !/0$ due to maternal or fetal conditions:
o LB": 5-/66 g at deli,er2
o LB": 58-/66 g at deli,er2
o 1LB": 58-666 g at deli,er2
9ge;elated %actors
8
8/13/2019 Preterm Labor and Preterm Contractions
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8/13/2019 Preterm Labor and Preterm Contractions
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.2mptoms: Low bac pain- pel,ic pressure- persistent contractions!painful or
painless$- increased ,aginal discharge- spotting- menstrual cramps- an2
respirator2 or urinar2 tract infections s2mptoms- leaage of ,aginal fluid
Ph2sical 1am
ital signs: Temperature- BP- pulse Ph2sical eam: Chec for source of infection:
o 9bdominal eam: 9ssess for uterine tenderness- %H- presentation
o ul,ar eam: Chec for lesions
o Cer,ical eam: Cer,ical dilation- effacement- position- consistenc2
Tests
%etal monitoring:
o
.T to assess fetal well being
o ?terine tocod2namometr2 for uterine contractions
%%:
o 1tracellular gl2coprotein that attaches the fetal membranes and
uterine decidua hours- do the
test between >)3> wees wees- oligoh2dramnios
o 9d,erse effects:
Maternal: ausea- ,omiting- gastritis
%etal: Constriction of ductus arteriosus- in utero pulmonar2
HT- oligoh2dramnios
#2tocin receptor antagonist
%ollowup
Disposition
4ssues for ;eferral
9ll patients should be referred and comanaged b2 M%M specialist
Prognosis
Based on 9 and associated medical conditions
Complications
.hort term: %eeding and growth difficulties- infection- apnea-neurode,elopmental difficulties- retinopath2- transient d2stonia
Long term: Cerebral pals2- sensor2 deficits- special needs- incomplete catch
up growth- school difficulties- beha,ioral problems- chronic lung disease
Patient Monitoring
Mother
ital signs for e,idence of infection
Contraction monitoring
%etus
.T
Bibliograph2
abbe .- et al< #bstetrics: ormal and 9bnormal Pregnancies< 4n: 4ams S- edth ed< Philadelphia: Churchill Li,ingstoneA 66:7//)*7< atl ital .tat ;ep!*$:8)8*!8($:8)36*:37=)3*/ cm dilation- singleton
pregnanc2- cephalic presentation- compliant patient
9bbre,iations
9%U9mniotic fluid
9%4U9mniotic fluid inde 9%PUV%etoprotein
C#RUC2cloo2genase
D1.UDieth2lstilberol
1LB"U1tremel2 low birth weight
%%U%etal fibronectin
%HU%undal height
9Uestational age
B.Uroup B streptococcus
HP9UH2pothalamus pituitar2 adrenal ais
4HU4ntra,entricular hemorrhage
LB"ULow birth weight L11PULoop electrosurgical ecision procedure
M%MUMaternalfetal medicine
.TUonstress test
#;U#dds ratio
PP;#MUPreterm premature rupture of membranes
PPUPositi,e predicti,e ,alue
PTBUPreterm birth
PTLUPreterm labor
;D.U;espirator2 distress s2ndrome
LB"Uer2 low birth weight
"H#U"orld Health #rganiEation
Codes
4CD=CM
(>>>