1、单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Preterm labor,Definition,Prematrue labor or delivery,Labor spontaneously occurring after 28 weeks but before 37 weeks gestation,fetal weight 2500g,Main cause of neonatal morbidity in developed countries,Etiology,Obstetric complications,Placenta abnormalities:Placenta previa,placenta abruption,Diabetes,hypertension,Polyhydramnios,oligohydramnios,Premature rupture of membrane,Multiple gestation,Previous laceration of cervix or uterus,Short internal betwe
2、en pregnancies(30mm,high negative predictive value,in the second and third trimesters,Fetal fibronectin,Protein of the choriodecidual matrix,Less than 50ng/ml,from cervicovaginal secretions after 20 weeks,until delivery begins,In posterior fornix,negative swab,predictive of absence of a Preterm labor within following 7 days,Treatment,Goals,Inhibit or reduce uterine contractions,Optimize fetal status before delivery,Short-term goal,Continue the pregnancy for 48h,after steriod administration,Long-
3、term goal,Continue the pregnancy beyond 34-37weeks,Evaluation,Gestational age,Fetal weight,Presenting part,Fetal monitoring,12,Treatment,Preterm labor should be allowed in following cases,Maternal diseases and disorders:,Severe hypertensive disease,Pulmonary or cardiac disease,Maternal severe hemorrhage,Fetal diseases and disorders:,Fetal death or distress,Intrauterine infection,Polyhydramnios accompanying with malformation,Others:,Cervical dilatation of more than 4cm,Ruptured membrane:,controve
4、rsy,Treatment,Bed rest,The most common interventions used for prevention and/or treatment of threatened preterm labor,Left lying,Treatment,Inhibit uterine contraction,Hydration/sedation,Pretherapy before tocolysis,When gravida without medical complications,Pethidine:50100mg im,Treatment,Tocolysis,The fetus is healthy,Gestational week is 2034(up to 37 week if no intensive neonatal care),Cervical dilatation,less than,4cm and effacement,less than 75,%,Membrane is intact,If not intact,tocolysis may
5、be administrated for usage of corticosteroids for 2448 hours,Until labor stops,Treatment,Antibiotics,Culture of bacteria and drug sensitivity test,Vaginal discharge,Amnionic fluid,Urinary system,Treatment,Accelerating fetal lung maturity,Glucocorticoids therapy,Mature pulmonary,Beta-methasone:12mg im,repeated once in 1224 hours,weekly,Dexamethasone:10mg iv,repeated once in 24 hours or 6mg im bid for 2 days,Treatment,Conduct of labor,Premature breech infants 15002000g maybe delivered by Cesarean
6、section,Avoid fetal hypoxia and intraventricular hemorrhage,Episiotomy should be made to reduce risk of injury,Aided by forceps,protect and guide the head,Treatment,Epidural anesthesia is best,then pudendal block,avoid paracervical block,Internal fetal monitor,scalp sampling for blood PH if suspect hypoxia,Intensive neonatal care,transfer is hazardous,Treatment,Prognosis,C,hance of permanent sequelae in direct relationship to fetal size,20002500g survival rate is 97%,15002000g 90%,10001500g 6580
7、%,8001350g 66%,Mortality and morbidity rates are higher in smaller fetuses,Prevention,Regular and good antenatal care,Treat pregnancy complication,Prevent premature rupture of membrane and subclinical infection,Suture cervical incompetence(cerclage)between 14,th,18,th,week,Thank you!,Treatment,-mimetic adrenergic agents:,2,the most common used,Increase cAMP in cell,decrease free calcium,relax uterus and uterine vessels,Side effects:hypotension,maternal and fetal tachycardia,decreased serum K,+,i
8、ncreased glucose and pulmonary edema,Contraindications,Cardiac disease,hyperthyroidism,uncontrolled hypertension and diabetes,asthma,Treatment,Ritodrine:,Initial dose is 50100,g,/min increased by 50,g/min,until labor stop,maintain for 12 hours.Max dose 350 g/min,10 mg po 30 min prior to stopping iv,followed by 10 mg every 2 hr or 20mg every 4 hr for 24 hr.If stable reduce to 1020mg every 4 to 6 hr.Max dose 120mg/day,Treatment,Terbutaline,initial dose is 10,g/min iv increase by 5,g/min every 10 min,max dose is 25,g/min,5mg po every 68 hr or 2.5mg every 4 hr,Sulbutamol,loading dose is 4.8mg po,followed 2.44.8mg every 8 hours,Treatment,Magnesium sulfate,Best alternative of beta-mimetic drugs,Compete with calcium,Side effects:had learned before,must carefully observe,Usage,Loading dose 4g iv for 3060 minutes followed by 2g/hour,5g im each buttock,followed by 5g/4 hours,
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