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is delivery befor 37 completed weeks it is the reason for 2/3 of fetal death . in first
year of live .The over all infant
mortality has continued to decline
but the mortality associated with
preterm birth is not.
Preterm birth
.
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Long term out comes.The high rate of significant neonatal morbidity in these
immature neonates and diminished likelilhood of
normal life must be weighed against the apparent
triumph of survival studies showed that follow up of
neonat born at 24 -26 wks. Report that only 20% totally
free of impairment at 5 y Theye are usually has
disabilities in mental and psychomotor develapment
neuromotor function’sensory and communication function .
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Economic impact.
They found that more than a1/3 of mony expended
for infant health care during the first year of life
is spent on the 7% of neonates born who weigh
less than 2500gm .additional
expenditures for developmental handicaps
during the remainder of childhood should also be
considered .
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Causes of preterm birth.
Medical and obstetrical
complications.PET .
Fetal distress .
IUGR .
APH
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LIFE STYLE FACTORS.
Smoking ,drug use Extreem of age
Poverty Vit c deficiency
Heavy work Long working hours.
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Recurrent familial and racial nature of preterm birth has
lead to suggestion that genetics may play a causal role
Gene for decidual relaxin .
Fetal mitochondrial
trifunctional protein defects Polymorphism in the
interleukin-1 gene complex B2 adrenergic receptor
defct .
–
GENETIC FACTORS
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Chorio amnionitis.
The pathway of bacteria to enter the (A.F) with
intact memb. Is unclear
E.coli can permeate living memb.
Bacterial endotoxin stimulate decidual
monocytes to produce cytokines which
stimulat arachidonic acid and prosta
glandins E2&F2 alph
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Bacterial vaginosis.
Lacto bacillus ( release hydrogeen
Replaced with anaerobes
peroxide(
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Periodontal disease
Oral bacteria especially
FusobacteriumIncrease the preterrm
labor by 7 fold.
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Fetal fibronection
•Glycoprotein .•Releas by fetal amnion .•Present in high conc. in maternal blood
&A.F •It is thought to playaroule in placenta adhesion to the
decidua •Present of fibonectin .•In cenvico vaginal secretion prior to memb •Rupture is possible marker for impending preterm laber.•(th predictive value for the delivery . Within 1wk in 30%)
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Management preterm rupture of memb .&preterm labor.
•Admission to L /R •Diagnosis of rupture memb .•Sterile speculum ex •Nitruzine test )pH of A.F 7-7.5 ( •False postive ) blood ,semen ,bacteral vaginosis (•Ferning test )Na .chlorid( •If the pt .less than34 wks •Start Antibiotic , fetal heart monitring •Beta methasone 12mg im 24 hr apart OR
dexamethasone 5mg /12hr )4doses (•
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Management of preterm labor with intact memb.
•Ademissiom to L/R
•Corticosteirod therapy thyrotropin releasing hormone )enhances surfactant
synthesis( • anti micrbials)clindamycin(
•Bed rest hydration&sedation
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TOCOLYTIC
B-adrenergic receptor agonists. Ritodrine
Delay deliviry for 48hrS.E ) pulmonary oedema ,hyper
glycemia ,hypokalemia ,arrhythmia, myocardial,ischemia(
Magnesium sulfateS.E ) respiratory depression ,diplopia , muscular
paralysis ,cardiac arrest ,(
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.•(indomethacin ) •In hibit P.G synth .or blocking P.G action on
target organs .•S /E ) oligohy dramnios ,renal failure( •(Calcium channel blocker )•(NIFEDIPINE )•S/E )hypotension ,decrease placenta
perfusion ,fetal hyper capnia ,acidosis ,hypoxia in(
•(anti oxytocin )
TOCOLYTIC