Preterm Labor and Preterm Contractions

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    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

    (>>>