PROM & Preterm Labor PDF

3 4 5 6 7 8 9 ◦ 10  Depends on ◦ Maternal condition-presence or absence of chorioamnionitis ◦ Fetal condition ◦ Gestational age 11 12 13 14  15 - 16  implement- surveillance for infection w...

3 4 5 6 7 8 9 ◦ 10  Depends on ◦ Maternal condition-presence or absence of chorioamnionitis ◦ Fetal condition ◦ Gestational age 11 12 13 14  15 - 16  implement- surveillance for infection when duration of PROM exceeds 12 hrs, which may include monitoring the following: 17 18  Dagim Shimelash(MD.) Gynecologist/ Obstetrician 2/9/2025 19 § Complications related to preterm birth account for more newborn and infant deaths than any other cause. § Although advances in neonatal care have led to increased survival and reduced short- and long- term morbidity for infants born preterm. Surviving infants have increased risk of visual and hearing impairment, chronic lung disease, cerebral palsy, and delayed development in childhood. 2/9/2025 20  § A preterm birth is defined as one that occurs after 28 weeks’ gestation and before the completion of 37 menstrual weeks of gestation, regardless of birth weight. § Preterm labor is defined by regular uterine contractions that occur before 37 weeks gestation and are associated with cervical change, birth prior to 28 weeks is an abortion. 2/9/2025 21  § Sub classifications of PTB are variably and inconsistently defined as:  Late preterm : 34 to 37 weeks  Moderately preterm : 32 to 34 weeks  Very preterm : 28 to 32 weeks  Extremely preterm : 3cm  Effacement of 80% or more 2/9/2025 45 You perform a speculum exam in order to obtain vaginal cultures, a GBS culture and fetal fibronectin. A sterile speculum exam is also necessary in order to check for ROM. 2/9/2025 46  § Investigations:  TVS: cervical length < 2.5 cm & funneling  Fetal fibronectin from vaginal discharge ◦ It is a protein that binds fetal membranes to decidua.  Other investigations based on etiologies like screening for genital & other infections. 2/9/2025 47  § WBC with differential § U/A, culture & sensitivity § Cervical & vaginal swab for culture & fibronectin § Ultrasound § Blood sugar level & electrolytes 2/9/2025 48 ü Goals of treatment include: 1. Prevent preterm labor 2. Arrest preterm labor 3. Appropriate management of labor 4. Effective neonatal care 2/9/2025 49  § Only 10-20 % of the mothers need arresting of labor. ü Bed rest ü Adequate hydration ü Prophylactic antibiotics: not routinely recommended ü Tocolytic agents: delay labor for adminstration of corticosteroids and in utero referral. 2/9/2025 50 § Maternal: uncontrolled DM, thyrotoxicosis, severe HTN, cardiac diseases, APH § Fetal: distress, Death, congenital anomalies, § Others: ROM, chorioamnionitis, cervical dilation > 4cm 2/9/2025 51 1. Prostaglandin synthase inhibitors: Indomethacin, Sulindac 2. Calcium Channel Blockers: Nifedipine 3. β- Adrenergic agonists: Ritodrine , terbutaline , salbutamole 4. Magnesium Sulfate 5. Newer tocolytics I). OXYTOCIN ANTAGONISTS II). NITRIC OXIDE DONOR DRUGS III). POTASSIUM CHANNEL OPENERS 2/9/2025 52  Principles: § Prevent birth asphyxia & development of RDS § Prevent birth trauma § 1st stage & 2nd stage management  Intensive clinical monitoring/ Continuous  Neonatal transfer to intensive care unit 2/9/2025 53  § RDS § Birth injury § IVH § Metabolic complications: Hypocalcemia,hypoglycemia, hypomagnesmia § Hypothermia § NEC § Hyperbilirubinemia § Infection § Malnutrition 2/9/2025 54 ü Fetal fibronectin ü Transvaginal sonography for funneling & cervical length. § Triage based on cervical length. Cervical length ≥ 30 mm - low risk of preterm birth Cervical length 20 to 30 mm - obtain a FN concentration Cervical length