扬州大学：《妇产科学》课程教学课件（PPT讲稿）10 早产 Preterm Labor

L/O/G/OPretermLaborFuDanDept.of Obstetrics&GynecologyNorthern Jiangsu Hospital

L/O/G/O Preterm Labor Fu Dan Dept. of Obstetrics & Gynecology Northern Jiangsu Hospital

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epidemiologyLabor and delivery between 28 - 36+6 weeks5%-10%: be the leading cause of perinatal morbidityand mortalitySurvivalrates haveincreased andmorbidity has decreased because oftechnologic 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

Categories and reasons: It can be divided into three categoriesaccording to the reasons about pretermbirth.-Spontaneouspretermlabor-Pretermprematurelyrupturedmembranes,PPROM-Pretermbirthformedicalandobstetricalindications

Categories and reasons • It can be divided into three categories according to the reasons about preterm birth. – Spontaneous preterm labor – Preterm prematurely ruptured membranes, PPROM – Preterm birth for medical and obstetrical indications

Spontaneous preterm labor Is the most common (about 45%)The mechanismisProgesterone withdrawal_ The role of oxytocin- Decidua activation

Spontaneous preterm labor • Is the most common (about 45%) • The mechanism is – Progesterone withdrawal – The role of oxytocin – Decidua activation

Spontaneous preterm laborThe high risk factors include:Bad habits (such as smokingPreviouspretermdelivery≥10/day,alcoholism)Pregnancyinterval is shorterthan18Poverty and loweducation groupsmonthsorgreaterthan5yearsThreatened abortion in earlyPregnancy labor intensivepregnancyIntrauterineinfection (primarilyUUExcessive expansion ofthe uterusand Mycoplasmahominis(polyhydramnios,multiplepregnancyBacterial vaginosisPlacenta(placentaprevia,placentalabruption,placentadysfunction)Periodontal DiseaseCertain immunomodulatory geneabnormalityYEPT

Spontaneous preterm labor Previous preterm delivery Bad habits (such as smoking ≥10/day, alcoholism) Pregnancy interval is shorter than 18 months, or greater than 5 years Poverty and low education groups Threatened abortion in early pregnancy Pregnancy labor intensive Intrauterine infection (primarily UU and Mycoplasma hominis) Excessive expansion of the uterus (polyhydramnios, multiple pregnancy) Bacterial vaginosis Placenta (placenta previa, placental abruption, placenta dysfunction) Periodontal Disease Certain immunomodulatory gene abnormality

Pretermprematurelyrupturedmembranes.PPROMThe reasons and high risk factors include:BMl<19.8kg/m2PreviousPPROMMalnutritionSmokeCervical incompetenceUterinemalformations(suchasuterineseptum,singlehornoftheuterus,doubleuterus)IntrauterineinfectionBacterial vaginosisExcessiveexpansionoftheuterusAssisted reproductivetechnology

Preterm prematurely ruptured membranes, PPROM Previous PPROM BMI <19.8kg/m2 Malnutrition Smoke Cervical incompetence Uterine malformations (such as uterine septum, single horn of the uterus, double uterus) Intrauterine infection Bacterial vaginosis Excessive expansion of the uterus Assisted reproductive technology

Pretermbirth for medicalandobstetricalindications: Delivery for maternal or fetal indications in whichlabor is induced or the infant is delivered byprelabor cesarean delivery Preeclampsia, fetal distress, small for gestational ageand placental abruption werethe most commonindications for medical intervention resulting inpreterm birth.-Otherlesscommoncauseswerechronichypertension, placenta previa, unexplained bleedingdiabetes, renal disease, Rh isoimmunization, andcongenital malformations

Preterm birth for medical and obstetrical indications • Delivery for maternal or fetal indications in which labor is induced or the infant is delivered by prelabor cesarean delivery – Preeclampsia, fetal distress, small for gestational age, and placental abruption were the most common indications for medical intervention resulting in preterm birth. – Other less common causes were chronic hypertension, placenta previa, unexplained bleeding, diabetes, renal disease, Rh isoimmunization, and congenital malformations

Forecast: To those pregnancy women who have riskfactors for spontaneous preterm labor,after 24 weeks, we can periodic forecastshelping preterm birth risk assessment,timely processing: To those who feel unusually frequentcontractions after 20 weeks, we candetermine whether they need to usetocolytic by predicting, avoiding excessivemedication

Forecast • To those pregnancy women who have risk factors for spontaneous preterm labor, after 24 weeks, we can periodic forecasts, helping preterm birth risk assessment, timely processing. • To those who feel unusually frequent contractions after 20 weeks, we can determine whether they need to use tocolytic by predicting, avoiding excessive medication

Prediction of preterm deliveryTransvaginal ultrasoundexamination:- cervical length 50ng/ml is positiveIf fFN test negative-negative predictive value about no dilivery in 1weeks is 97%-negative predictive value about no dilivery in 2weeks is 95%

Prediction of preterm delivery • Transvaginal ultrasound examination: – cervical length 50ng/ml is positive – If fFN test negative – negative predictive value about no dilivery in 1 weeks is 97% – negative predictive value about no dilivery in 2 weeks is 95%