57 - Preterm Labor Preterm Labor 早早 早早早...

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Unformatted text preview: Preterm Labor Preterm Labor 早早 早早早 epidemiology epidemiology Labor and delivery between 28 – 36+6 weeks 5%­10% be the leading cause of perinatal morbidity and mortality Survival rates have increased and morbidity has decreased because of technologic advances Risk Factors Risk Factors Previous preterm delivery • Low socioeconomic status • • Maternal age <18 years or >40 years • Preterm premature rupture of the membranes • Multiple gestation • Maternal history of one or more spontaneous second­trimester abortions • Maternal complications (medical or obstetric) ­­Lack of prenatal care • Uterine causes • Myomata (particularly submucosal or subplacental) Uterine septum Bicornuate uterus Cervical incompetence • Abnormal placentation • Infectious causes • Chorioamnionitis Bacterial vaginosis Asymptomatic bacteriuria Acute pyelonephritis Cervical/vaginal colonization • Fetal causes Intrauterine fetal death Intrauterine growth retardation Congenital anomalies diagnosis diagnosis cervical effacement and/or dilatation increased uterine irritability before 37 weeks of gestation forecast: uterine activity monitoring. Ultrasound Examination of Cervical length Fetal Fibronectin treatment treatment Bed Rest Tocolysis Corticosteroid Therapy Antibiotic Therapy Although bed rest is often prescribed for women at high risk for preterm labor and delivery, there are no conclusive studies documenting its benefit. A recent meta­analysis found no benefit to bed rest in the prevention of preterm labor or delivery. Tocolytic therapy may offer some short­ term benefit in the management of preterm labor. A delay in delivery can be used to administer corticosteroids to enhance pulmonary maturity and reduce the severity of fetal respiratory distress syndrome, also be used to facilitate transfer of the patient to a tertiary care center No study has convincingly demonstrated an improvement in survival, long­term perinatal morbidity or mortality, or neonatal outcome with the use of tocolytic therapy alone. Tocolytic Therapy Magnesium sulfate (Intracellular calcium antagonism) Terbutaline (Bricanyl) Beta2­adrenergic receptor agonist sympathomimetic; decreases free intracellular calcium ions Ritodrine (Yutopar) Same as terbutaline Nifedipine (Procardia) Calcium channel blocker Indomethacin (Indocin) Prostaglandin Potential Complications Associated With the Potential Complications Associated With the Use of Tocolytic Agents : Magnesium sulfate • Pulmonary edema • Profound hypotension* • Profound muscular paralysis* • Maternal tetany* • Cardiac arrest* • Respiratory depression* Beta­adrenergic agents Beta­adrenergic agents • Hypokalemia • Hyperglycemia • Hypotension • Pulmonary edema • Arrhythmias • Cardiac insufficiency • Myocardial ischemia • Maternal death Indomethacin (Indocin) Indomethacin (Indocin) • Renal failure • Hepatitis • Gastrointestinal bleeding Nifedipine (Procardia) • Transient hypotension Corticosteroid Therapy Dexamethasone and betamethasone for fetal maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in infants between 28 and 35 weeks of gestation. benefits start at 24 hours and last up to seven days after treatment The potential benefits or risks of repeated administration of corticosteroids after seven days are unknown. women who received antibiotics sustained pregnancy twice as long as those who did not receive antibiotics had a lower incidence of clinical amnionitis. poor fetal outcome (death, respiratory distress, sepsis, intraventricular hemorrhage or necrotizing colitis) occurred less frequently in women receiving antibiotics ...
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