Preterm Labour
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Transcript of Preterm Labour
PRETERM LABOUR
Lekshmi L V2007 MBBS
DEFINITION
Preterm labour – spontaneous expulsion of products of conception after viability and before 37 completed weeks.
Threatened preterm – uterine contractions +
but no corresponding cx dilatation
Incidence is increasing; No specific etiology
RISK FACTORS
Infections of genital tract - chorioamnionitis
Past reproductive history –
prev. preterm birth is the single most important risk factor
prev. induced abortion or 1st/2nd trimester loss
Maternal factors
extremes of age
under nutrition
low socioeconomic status
smoking
stress
lack of ANC
Pregnancy complications
Multiple pregnancy Polyhydramnios Asymptomatic bacteriuria APH Pre eclampsia Fetal malformations Maternal illness or systemic inf
Uterine factors
cervical incompetence uterine anomalies submucous fibroid
TYPES
Spontaneous
Iatrogenic – IUGR, pre eclampsia, abruption
Preterm PROM
PREDICTION OF PRETERM LABOUR
Prior preterm labour
Clinical cervical assessment
TVS cervical assessment – 2.5cm cut off
Fetal fibronectin - ≥ 50 ng/ml
Other markers – maternal salivary oestriol, plasma CRH
Home uterine activity monitoring
In a women with previous preterm labour, fetal fibronectin ≥ 50 ng/ml & cervix length < 2.5cm on TVS – best predictor
DIAGNOSIS
CRITERIA :
Contractions – 4 in 20 min
Cx dilatation > 1cm
Cx effacement – 75% or more
PREVENTION
Improve general health & nutrition
Better antenatal care
Cx encerclage for incompetence
Conservative management of PROM
THANK YOU