上海交通大学医学院：《妇产科学》（双语） 57 Preterm labor

Preterm labor 早产 林建华

Preterm Labor 早 产 林建华

epidemiology Labor and delivery between 28-36+6 weeks 5%-10 a be the leading cause of perinatal morbidity and mortality Survival rates have increased and morbidity has decreased because of technologic advances

epidemiology ◼ Labor and delivery between 28 – 36+6 weeks ◼ 5%-10% ◼ be the leading cause of perinatal morbidity and mortality ◼ Survival rates have increased and morbidity has decreased because of technologic advances

Risk factors Previous preterm delivery Low socioeconomic status °· Maternal age40 years Preterm premature rupture of the membranes Multiple gestation Maternal history of one or more spontaneous second-trimester abortions Maternal complications (medical or obstetric) - Lack of prenatal care

Risk Factors ◼ Previous preterm delivery • Low socioeconomic status • • Maternal age 40 years • Preterm premature rupture of the membranes • Multiple gestation • Maternal history of one or more spontaneous second-trimester abortions • Maternal complications (medical or obstetric) --Lack of prenatal care

Uterine causes Myomata(particularly submucosal or subplacental) Uterine septum Bicornuate uterus Cervicalincompetence Abnormal placentation

• Uterine causes Myomata (particularly submucosal or subplacental) Uterine septum Bicornuate uterus Cervical incompetence • Abnormal placentation

Infectious causes Chorioamnionitis Bacterial vaginosis Asymptomatic bacteriuria Acute pyelonephritis Cervical/vaginal colonization Fetal causes Intrauterine fetal death Intrauterine growth retardation Congenital anomalies

• Infectious causes Chorioamnionitis Bacterial vaginosis Asymptomatic bacteriuria Acute pyelonephritis Cervical/vaginal colonization • Fetal causes Intrauterine fetal death Intrauterine growth retardation Congenital anomalies

diagnosis cervical effacement and/or dilatation a increased uterine irritability before 37 weeks of gestation forecast: uterine activity monitoring. a Ultrasound Examination of Cervical length ■ Fetal fibronectin

diagnosis ◼ cervical effacement and/or dilatation ◼ increased uterine irritability before 37 weeks of gestation forecast: ◼ uterine activity monitoring. ◼ Ultrasound Examination of Cervical length ◼ Fetal Fibronectin

treatment Bed rest ■1 ocolys1s a Corticosteroid Therapy a Antibiotic Therapy

treatment ◼ Bed Rest ◼ Tocolysis ◼ Corticosteroid Therapy ◼ Antibiotic Therapy

Although bed rest is often prescribed for women at high risk for preterm labor and delivery, there are no conclusive studies documenting its benefit A recent meta-analysis found no benefit to bed rest in the prevention of preterm labor or deliverv

◼ Although bed rest is often prescribed for women at high risk for preterm labor and delivery, there are no conclusive studies documenting its benefit. ◼ A recent meta-analysis found no benefit to bed rest in the prevention of preterm labor or delivery