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    Gyno... PTL & PRO

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    hailemichael chekol
    This document discusses preterm labor and premature rupture of membranes. It defines preterm labor as labor starting before 37 weeks of gestation and notes that it is a major cause of perinatal morbidity and mortality. Risk factors for preterm labor include previous preterm births, infections, smoking, and nutritional status. Management involves preventing preterm labor, arresting it if it occurs, and providing appropriate neonatal care. Premature rupture of membranes is defined as rupture of membranes before labor begins at 37 weeks, and complications include preterm birth and infection. Conservative management is recommended for preterm premature rupture of membranes depending on gestational age and fetal/maternal condition.

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    Gyno... PTL & PRO

    Uploaded by

    hailemichael chekol
    27 views30 pages
    This document discusses preterm labor and premature rupture of membranes. It defines preterm labor as labor starting before 37 weeks of gestation and notes that it is a major cause of perinatal morbidity and mortality. Risk factors for preterm labor include previous preterm births, infections, smoking, and nutritional status. Management involves preventing preterm labor, arresting it if it occurs, and providing appropriate neonatal care. Premature rupture of membranes is defined as rupture of membranes before labor begins at 37 weeks, and complications include preterm birth and infection. Conservative management is recommended for preterm premature rupture of membranes depending on gestational age and fetal/maternal condition.

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    Gyno...PTL_&_PRO

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    This document discusses preterm labor and premature rupture of membranes. It defines preterm labor as labor starting before 37 weeks of gestation and notes that it is a major cause of perinatal morbidity and mortality. Risk factors for preterm labor include previous preterm births, infections, smoking, and nutritional status. Management involves preventing preterm labor, arresting it if it occurs, and providing appropriate neonatal care. Premature rupture of membranes is defined as rupture of membranes before labor begins at 37 weeks, and complications include preterm birth and infection. Conservative management is recommended for preterm premature rupture of membranes depending on gestational age and fetal/maternal condition.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    27 views30 pages

    Gyno... PTL & PRO

    Uploaded by

    hailemichael chekol
    This document discusses preterm labor and premature rupture of membranes. It defines preterm labor as labor starting before 37 weeks of gestation and notes that it is a major cause of perinatal morbidity and mortality. Risk factors for preterm labor include previous preterm births, infections, smoking, and nutritional status. Management involves preventing preterm labor, arresting it if it occurs, and providing appropriate neonatal care. Premature rupture of membranes is defined as rupture of membranes before labor begins at 37 weeks, and complications include preterm birth and infection. Conservative management is recommended for preterm premature rupture of membranes depending on gestational age and fetal/maternal condition.

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    of 30

    Dr Bantayehu Nega,(Assistant professor of

    Obstetrics and Gynecology , Bahir Dar


    University)
    Introduction
    Definition: When labor starts before 37 completed weeks (<259
    Days) from LNMP & after viability.
    • It is significant cause of perinatal morbidity & mortality
    • PTL is also a major determinant of short- and long-term
    morbidity in infants and children.
    Magnitude:
    • Prevalence varies widely, Ranges between 5-15%( 10 %)
    Con’t …
    • Neonates born before term can be small or large for
    gestational age but are still preterm by definition
    – Low birth weight (LBW) — BW less than 2500 g
    – Very low birth weight (VLBW) — BW less than 1500 g
    – Extremely low birth weight (ELBW) — BW less than 1000 g
    Con’t…
    • Prematurity, represents incomplete development of various
    organ systems at birth.
    – The lungs are particularly affected and may be susceptible
    to the respiratory distress syndrome
    • Approximately 70 to 80 percent of PTBS occur spontaneously.
    – 40 to 50 % due to preterm labor
    – 20 to 30 % due to PPROM
    • The remaining 20 to 30 percent of PTBS are due to
    intervention for maternal or fetal problems
    Etiology Of PTL
    • Cause is unknown in 50% of cases
    • Cause is of multifactorial and associated with different
    factors
    Risk factors for PTL

    • Previous history of preterm labor, induced or


    spontaneous abortion
    • Asymptomatic Bactriuria/UTI
    • Smoking
    • Low socioeconomic status/ Nutritional status
    Risk factors- cont’d
    Complications in current pregnancy: Maternal, fetal or
    placental
    • Maternal:
    - Pregnancy complications: APH, PROM, Preeclampsia,
    polyhydraminos
    - Uterine anomalies: Cervical incompetence, malformations
    of the uterus
    - Medical & surgical illness: acute fever, appendicitis
    - Genital tract infections: BV, chlamydial
    Risk- cont’d

    • Fetal: Multiple pregnancy, Congenital malformations, IUFD


    • Placental: Infarction, thrombosis, Abruption
    Iatrogenic: wrong GA estimation, termination of pregnancy for
    obstetric indications

    Idiopathic: Half of cases


    Diagnosis
    • History: lower abdominal pain /pushing down pain, leakage of
    liquor, pelvic pressure
    • Physical findings:
    - Regular uterine contractions
    - Progressive change in Cervical dilatation

    - Change in effacement
    Diagnosis- cont’d
    • 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.


    Lab. investigations
    • CBC for WBC with differential
    • U/A, urine culture & sensitivity
    • Cervical & vaginal swab for culture
    • Ultrasound

    • Blood sugar level


    Management

    • Goals of treatment include:


    o Prevent preterm labor
    o Arrest preterm labor

    o Appropriate management of labor


    o Effective neonatal care
    Management…
    • Four interventions that have been shown to reduce neonatal
    morbidity and mortality:
    1. Antenatal transfer of the mother and fetus to the most
    appropriate hospital.
    2. Antibiotics in labor to prevent neonatal infection
    3. Antenatal administration of glucocorticoids to the mother
    4. Administration of maternal magnesium sulfate
    TOCOLYTIC AGENTS
     Tocoloysis is inhibition of myometrial contractions

    1. Prostaglandin synthase inhibitors. Eg. Indomethacin


    2. Calcium Channel Blockers. Eg. Nifedipine
    3. β- Adrenergic agonists. e.g. Ritodrine , terbutaline
    4. Magnesium Sulfate
    Complications of preterm delivery

    • RDS
    • Birth injury
    • IVH
    • Metabolic complications: Hypocalcemia, hypoglycemia,
    hypomagnesmia
    • Hypothermia
    • NEC
    • Hyperbilirubinemia
    • Infection
    • Malnutrition
    PROM (Premature rupture of membranes)
    Premature rupture of membranes

    Definition: Spontaneous rupture of membranes after 28 weeks


    of gestation before the onset of labor.
    • Term PROM: Rupture of membranes after 37 weeks
    • Preterm PROM: Before 37 weeks

    • Prolonged PROM: Longer than 8hrs.


    • Latency period: Time between rupture of membranes to
    onset of labor.
    PROM- cont’d
    Incidence: average around 10%, ranges 3-19 %.
    Causes: Not known in majority. Possible causes include:
    • Increased fragility of membranes
    • Decreased tensile strength of membranes
    • Polyhydraminos
    • Cervical incompetence
    • Multiple pregnancy
    • Infection
    • Emergent circlage
    PROM-Cont’d
    Diagnosis:
    • History: complaint of leakage of liquor as gush or slow leak
    • Physical findings:
    - Negative discrepancy
    - If complicated, uterine contraction, tenderness
    - Sterile speculum examination with or without valsalva
    maneuver( leakage or pooling)
    Diagnosis-cont’d

    Investigations:

    • Nitrazine paper test

    • Ferning pattern

    • Ultrasound: support diagnosis & fetal wellbeing.

    • Dye test: indigo carmine instillation


    PROM- investigations
    • CBC
    • U/A, urine Culture & Sensitivity
    • High vaginal swab for culture
    • Obstetric ultrasound

    • CTG for nonstress test


    • Routine test like VDRL,HbsAg,BG&Rh,PICT
    Differential diagnosis for PROM

    • Urinary incontinence
    • Leucorrhea gravidarum
    • Perspiration
    • Vaginal discharge-pathological

    • Increased physiological vaginal discharge


    Complications of PROM

    • Preterm Labor
    • Ascending infection: one third
    • Increased incidence of cord prolapse
    • Fetal pulmonary hypoplasia

    • Prematurity
    • Abruption
    Management

    • Accurate diagnosis
    • Avoid digital vaginal examination
    • Bed rest
    • Management depends on:
    - GA
    - Presence or absence of labor
    - Maternal condition
    - Fetal condition
    Indications for pregnancy termination in PROM

    • Term PROM
    • Labor
    • Presence of infection
    • IUFD

    • Congenital anomalies of fetus incompatible to life


    • Abnormal fetal surveillance
    Preterm PROM
    • GA > 34 weeks is controversial either conservative management
    or termination
    • GA< 34 weeks, conservative management

    • Components of conservative management:

    - Monitor maternal PR, Temp,BP ,RR, FHR every 4 hours

    - CBC, U/A twice per week

    - Corticosteroids if less than 37 weeks

    - Administer antibiotics: Ampicillin, amoxacillin & azithromycin

    - Follow with PROM and kick chart


    Chorioamnionitis

    • Clinical or subclinical
    • Criteria for clinical chorioamnionitis:
    - Maternal temperature > 38o C
    - Uterine tenderness

    - Foul smelling amniotic fluid


    - High WBC count >15k
    - Maternal &/ or fetal tachycardia
    Sub clinical chorioamnionitis

    • Amniocentesis: intramniotic infection is present if:


    1. Culture: bacterial colony count > 102 / ml fluid
    2. Presence of bacteria on gram stain

    3. Glucose level<15 mg/dl


    4. WBC> 100/ml
    Management of chorioamnionitis

    • Antibiotics:
    1. Ampicillin + clindamycin
    2. Ampicillin + Gentamycin ± metronidazol

    3. Ceftriaxone +/- metronidazole


    • Terminate pregnancy: Vaginal route is preferred
    Thanks

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