Preterm labor and PROM

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Preterm labor and PROM Dr. Wisit Woranitat

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Preterm labor and PROM. Dr. Wisit Woranitat. Preterm labor. What is preterm labor How dose labor start What can happen if my baby is born too early What factors increase the risk of preterm labor What are the signs and symptoms of preterm labor How can preterm labor be diagnosed. - PowerPoint PPT Presentation

Transcript of Preterm labor and PROM

Page 1: Preterm labor and PROM

Preterm labor and PROM

Dr. Wisit Woranitat

Page 2: Preterm labor and PROM

Preterm labor• What is preterm labor

• How dose labor start

• What can happen if my baby is born too early

• What factors increase the risk of preterm labor

• What are the signs and sympto ms of preterm labor

• How can preterm labor be diagnosed

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Preterm labor• If I am at risk of preterm la

bor, what can I do to decr ease the risk

• How do I monitor myself f or contraction

• What medications are use d to slow or stop per term

• What are the special need s of preterm babies

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What is preterm labor

• 37The labor begin start before weeks

• 1 10About in babies born in USA

• 75% of neonatal mortality

• 50% of the long term neurologic impairment in children

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How does labor start

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What can happen if my baby is born too

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• Eyes

• Ears

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• Nervous system

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Perinatal Morbidity

- Pulmonary RDS bronchopulmonary dyspRRRRR

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Perinatal morbidity

Infections: GBS, E. Coli SIDS Psychosocial:> prevalence of child abuse

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PathogenesisPathogenesis• 80% of Preterm births are spontaneous

• 50% Preterm labor

• 30% Preterm premature rupture of the membraRRR

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RRRRRR RRRRRRRRR RRRR• RRRRRRRRR• RRRRRRRR RRRRRRRRRR• Pathologic uterine distention

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Previous History Smoking

Cocaine use & DES Multiple pregnancy

Abn Cx & Ut Surgery

Bleeding 2 half Hydramnios

Infection Poor ANC

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What are the signs a nd symptoms of pre

term labor Vaginal discharge Pelvic&Abd pressure

Backache Abd cramps

Ut contraction PROM

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How can preterm labor bediagnosed

• Cervical change

• Regular contraction

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• Fetal mornitoring

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Biologic markers for predicti ng preterm birth

• - Cervical length measurement many studRRR RRRR RRRRRRR RR RR RRRRRRRRRRR R RRR RR

rvical shortening and preterm delivery. When combined with positive fetal fibron

2 .5 ,ectin and length less than cm this isR RRRRRR RRRRRRRRR RR RRRRRRR RRRRRRRR

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Biologic markers for predicti ng preterm birth

• - Fetal fibronectin need intact membranes 3, less than cm dilated, not useful befor 24 34 6e weeks or after weeks day

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• Negative fetal fibronectin gives about a 9 5 1% chance of the pregnancy continuing

4days or more. A positive test is not as predictive.

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What can I do to dec rease the risk of pre

term labor• Early ANC

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• Progesterone

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How do I monitor m yself for contraction

• Monitor for sign of uterine activity

• 4 20times in minutes

• 8 60times in minute

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• PROM

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What medications a re used to slow or st

op preterm• Tocolysis agents

•Corticosteroid

• - Anti biotic agent

Bricanyl Calcium Chanel blocker

• NSAIDS• Oxytocin antagonist

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Assessment of patients in pr eterm labor

- - Labs CBC, UA +/ culture, electrolytes RRRRRRR RRRRRRRR RRRR RRRRRRRRR RRRRRRR

s for group B strep, BV, GC, Chlamydia, oRRRRR RRRRR RRRRRRRRRRR

Cervical length measurement RRR RRRR RRRRR RR RRR RRRRRRRR RRRRRR

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What are the special needs of preterm babies

•NICU

• Breathe

• Eat

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Premature rupture o f membrane

•Definition

• Incidence

•Diagnosis

• Risk factors

•Management

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Definition Premature rupture of membranes (PROM)

Rupture of the chorioamnionic membrane pri or to the onset of labor at any stage of gestati

on

Preterm premature rupture of membra nes (PPROM)

- PROM prior to 37 wk. gestation

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Incidence PROM – 12% of all pregnancies PROM – 8% term pregnancies PPROM – 30% of preterm deliveries

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Diagnosis History

“ Gush” of fluid Steady leakage of small amounts of fluid

Physical Sterile vaginal speculum exam

Minimize digital examination of cervix, regardl ess of gestational age, to avoid risk of ascendi

ng infection/amnionitis Assess cervical dilation and length Obtain cervical cultures (Gonorrhea, Chlamydi

a) Obtain amniotic fluid samples

Findings Pooling of amniotic fluid in posterior vaginal for

nix Fluid per cervical os

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Diagnosis• Test or investigation

• Nitrazine test

• Fern test

• Nine blue test

• Ultrasound

• - Indigo carmine Amnioinfusion

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Nitrazine test

Fluid from vaginal exam placed on strip of nitrazin

e paper Paper turns blue in prese

nce of alkaline (pH > 7.1) amniotic fluid

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Fern test

Fluid from vaginal e xam placed on slide

and allowed to dry Amniotic fluid narro

w fern vs. cervical mucus broad fern

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Nile blue tests

• >32 wks. Fetal fat cell can discover in amniotic fluid

• Strained with Nile blue sul phate. Become to red colo

r

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Fetal Fibronectin (AmniSure)

• Newer test

• Point of Care test

• - Cost up to $50 each

• - -Sensitivity 98.7 98.9%

• - -87510Specificity .0%

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UltrasoundRRRRRR RR RRRRRR RRRRR RRRRR RRR RRR RRR

ibility with PROM

- Indigo carmine AmnioinfusionR RRRRRRRRR RRRRRR RRRRRR RRRR RRR RRR

amnioinfusion (“Blue tap”) Observe for passage of blue fluid from va

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Risk factor of PROM Prior PROM or PPROM Prior preterm delivery Multiple gestation Polyhydramnios Incompetent cervix Vaginal/Cervical Infection

Gonorrhea, Chlamydia, GBS, S. Aureus Antepartum bleeding (threatened abortion) Smoking Poor nutrition

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Effect to mother and fetus

• - Feto maternal infection

• Placenta abruptio

• - Premature infant: 30% 40% of premature la bour is associated with premature rupture of

membrane

• Cord prolapse, cord compression

• Poor fetal lung development and fetal compre ssion syndrome

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Management

PROM at term:

1( ) Awaiting the onset of spontaneous labor

-1224for h

2 24( ) Termination of pregnancy after hourr

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PROM before term Termination of pregnancy

1( ) Evidence of fetal rrrrrrrrr rrrrrrrrrr (2 ) Evidence of intrauterine infection

Expectant therapy Indication : (1) Evidence of fetal pulmonary immaturation r rrrrrr rrrrrrrr rr rrrrrrrrrrrr rrrrrrrrr 2

Management: 1( )To enhance fetal pulmonary maturation 2( ) Antibiotic 3( ) Tocolysis

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Management: Rationale

Antibiotics Prolong latency period Prophylaxis of GBS in neonate Prevention of maternal chorioamnionitis and neonatal se

psis

Corticosteroids Enhance fetal lung maturity Decrease risk of RDS, IVH, and necrotizing enterocolitis

Tocolytics Delay delivery to allow administration of corticosteroids Controversial, randomized trials have shown no pregnan

cy prolongation

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Management: Surveillance

Maternal: Monitor for signs of infect ion

Temperature Maternal heart rate Fetal heart rate Uterine tendernessContractions

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Management: Surveillance

-Fetal: Monitor for fetal well being Kick counts Nonstress tests (NST’s) Biophysical profile (BPP)

Im m ediate Delivery Intrauterine infection Abruptio placenta Repetitive fetal heart rate decelerations Cord prolapse.

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Thank you For your attention