Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drpradeepgarg.com

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Preterm Labour (PTL) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Magnitude of the Problem ,[object Object],[object Object],[object Object]

Pathways to Preterm labour proteases PT L Uterine Contractions Cervical Change • Infection: - Chorion-Decidual - Systemic Decidual Hemorrhage CRH E1-E3 Thrombin Thrombin Rc Pathological Uterine Distention • Multifetal Pregnancy • Polyhydramnios • Uterine Abnormality Inflammation • Maternal-Fetal Stress • Premature Onset of Physiologic Initiators Activation of Maternal-Fetal HPA Axis CRH + Chorion Decidua uterotonins Mechanical Stretch Gap jct PG synthase Oxt recep PPROM Ils, Fas L TNF + Abruption Source: Lockwood CL. Unpublished data, 2002.

History of previous preterm birth Primary risk for a preterm delivery in multiparas is a history of previous preterm birth (relative risk [RR] 2.62) Mercer BM,Am J Obstet Gynecol. 1999;181:1261–1221 Evaluation of the literature shows that history of a previous preterm delivery is consistently the most important risk factor for subsequent preterm birth.

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INFECTION … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],R Goldenberg NEJM 2000

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How do we identify who is at Risk? Preterm Birth Risk Factors Cervical Length Fetal Fibronectin Symptoms of PTL

[object Object],[object Object],0-5:low risk 5-9 :medium risk ≥ 10 :high risk points Socio economic factors Previous medical history Daily habits Current pregnancy 1 2 children at home; low s.e status 1 abortion <1 yr since last birth Works outside Unusual fatigue 2 Age<20/>40 yr Single parent 2 abortions Smoke>10 cig/day >3 flights of stairs without elevator Gain<5 kg by 32 wk Albuminuria,bacteriuria,hypertension 3 V low s.e status Ht<150 Wt<45 kg 3 abortions Heavy/stressful work Long daily commuting Extensive travelling breech@32 wks Head engaged @32 wks Febrile illness 4 Age<18 yrs pyelonephritis Bleeding after 12wk Short cervix Open int os Uterine irritabily 5 Uterine anomaly T2 abortion Des Exp Cone bx Placenta praevia hydramnios 10 Ptb,repeated t2 abortion Twins Abdominal surgery

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Fetal fibronectin (cont) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Prevention/Intervention Strategies Tocolytics Education Targeting High Risk Women Bedrest Home Uterine Monitoring Frequent Digital Exam Hydration Population Based strategies

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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Goals 1. allow administration of corticosteroids 2. allow time for transfer to tertiary care 3. during maternal antenatal surgeries 4. uterine relaxation during ECV

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Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drpradeepgarg.com