Preterm laborPreterm laborBy: Dani Mamo Aws Nabeel Umed Muayad

( 4th course , 8th semester )

This presentation is about preterm labor and contain many short topics and prepared by 4th course student of ivane javakhichvili tbilisi state university .

this presentation is prepared by Dani Mamo , and

the questions are prepared by Aws Nabeel and Umed Muayad.

What is preterm labor?

• Preterm labor is defined as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal).

• by WHO is defined as Onset of labour prior to the completion of 37 weeks of gestation, in a pregnancy beyond 20 weeks of gestation.

• preterm birth: when birth occurs between 20 weeks of pregnancy and 37 weeks of pregnancy, it is called preterm birth.

• If uterine contractions are perceived in the absence of cervical change, the condition is called Threatened Preterm Labour. This condition tends to be over diagnosed and over treated.Nearly 50-60% of preterm births occur following spontaneous labour. 30% due to preterm premature rupture of membranes Rest are iatrogenic terminations for maternal or fetal benefit.

Why is preterm birth a concern?

• Preterm birth is a concern because babies who are born too early may not be fully developed. They may be born with serious health problems. Some health problems, like cerebral palsy, can last a lifetime. Other problems, such as learning disabilities, may appear later in childhood or even in adulthood.

Incidence

• Preterm birth occurs in 5-12% of all pregnancies and accounts for majority of neonatal deaths and nearly half of all cases of congenital neurological disability, including cerebral palsy. A neonate weighing 1000- 1500 g today has ten times greater chance of surival then what it had in 1960s.The focus is hence shifting to early preterm births(<32 weeks) which account for 1-2% of all births but contribute to 60% of perinatal mortality and nearly all neurological morbidity.

the risk of health problems

• The risk of health problems is greatest for babies born before 34 weeks of pregnancy. But babies born between 34 weeks of pregnancy and 37 weeks of pregnancy also are at risk.

Risk factor

• Having a previous preterm birthHaving a short cervixShort interval between pregnanciesHistory of certain types of surgery on the uterus or cervixCertain pregnancy complications, such as multiple pregnancy and vaginal bleedingLifestyle factors such as low prepregnancy weight, smoking during pregnancy, and substance abuse during pregnancy

Sign and symptoms1- Change in type of vaginal discharge (watery, mucus,

or bloody)2- Increase in amount of discharge3- Pelvic or lower abdominal pressure4- dull backache5- Mild abdominal cramps, with or without diarrhea6- Regular or frequent contractions or uterine

tightening, often painless7- Ruptured membranes

Tests and diagnosis

• Pelvic exam• Ultrasound• Uterine monitoring • Lab tests• Maturity amniocentesis

• Pelvic exam : the health care provider might evaluate the firmness and tenderness of the uterus and the baby's size and position. pelvic exam is to determine if the cervix has begun to open — if the water hasn't broken and the placenta isn't covering the cervix (placenta previa).

• Ultrasound: An ultrasound might be used to measure the length of the cervix and determine a baby's size, age, weight and position in the uterus. and might need to be monitored for a period of time and then have another ultrasound to measure any changes in the cervix, including cervical length.

• Uterine monitoring: the health care provider might use a uterine monitor to measure the duration and spacing of the contractions.

• Lab tests: the health care provider might take a swab of the vaginal secretions to check for the presence of certain infections and fetal fibronectin ( a substance that acts like a glue between the fetal sac and the lining of the uterus and is discharged during labor). However, this test isn't reliable enough to be used on its own to assess the risk of preterm labor.

• Maturity amniocentesis: the health care provider might recommend a procedure in which amniotic fluid is removed from the uterus (amniocentesis) to determine the baby's lung maturity. The technique can also be used to detect an infection in the amniotic fluid.

Treatment

• For some women, a surgical procedure known as cervical cerclage can help prevent premature birth. During this procedure, the cervix is stitched closed with strong sutures. Typically, the sutures are removed when the baby is considered full term — during week 37 of pregnancy. If necessary, the sutures can be removed earlier.

• Cervical cerclage might be recommended if she is less than 24 weeks pregnant, and she had a history of early premature birth and an ultrasound shows that the cervix is opening or that the cervical length is less than 25 millimeters.

• Corticosteroids: if the period is between weeks 24 and 34, the health care provider might recommend an injection of potent steroids to speed the baby's lung maturity. After week 34, the baby's lungs might be mature enough for delivery without steroids.

• Magnesium sulfate: Although this medication isn't likely to prolong the pregnancy, some research has shown that it may reduce the risk of a specific type of damage to the brain (cerebral palsy) for babies born before 32 weeks of gestation.

• Tocolytics: is used to temporarily stop the contractions.

Dani mamo