Prematurity Flashcards by Ahmed Farag

Q

A

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Q

Etiology & RF for Prematurity

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Etiology & RF for Prematurity

Maternal Factors

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Etiology & RF for Prematurity

fetal Factors

A

1) Fetal anomalies
2) multiple infections as TORCH
3) IUFD.

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Etiology & RF for Prematurity

obstetric Compications

A

1) Polyhydramnios, PPROM
2) Chorioamnionitis
3) placenta previa, placental abruption
4) pregnancy on top of IUD.

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Etiology & RF for Prematurity

Iatrogenic Factors

A

1) Premature induction of labor
2) ECV
3) amniocentesis or surgery.

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Etiology & RF for Prematurity

Idiopathic

A

In 50% of cases

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Etiology & RF for Prematurity

Commonest Cause

A

Idiopathic

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Q

Complications of Prematurity

A

Long term
Short term

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Complications of Prematurity

Long-term

A

↑↑ incidence of underdevelopment.
↑↑ incidence neurological & intellectual abnormalities later in life.

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Complications of Prematurity

short Term

A

Respiratory
Brain
Blood
Metabolic
Others

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Short term Complications of Prematurity

Respiratory

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Dx of Preterm Labor

A

Prediction
Manifestations of threatened preterm labor
Criteria to document preterm labor

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Dx of Preterm Labor

Prediction

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Dx of Preterm Labor

Manifestations

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Dx of Preterm Labor

Criteria

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Q

Dx of Prematurity

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A

Before delivery
After delivery (Features of prematurity at birth)

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Dx of Prematurity

Before Delivery

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A

Tests for determination of fetal maturity

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Dx of Prematurity

After Delivery

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A

Q

Prevention of Preterm Labor

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A

General
Rest
Cervical Cerclage
Prophylactic tocolytic

Q

Prevention of Preterm Labor

general Measures

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Q

Prevention of Preterm Labor

rest

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A

In high risk cases as in:
- cervical incompetence, multifetal pregnancy.
- previous preterm labor, PPROM or after uterine manipulation

Q

Prevention of Preterm Labor

cervical Cerclage

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A

Done when indicated as in:
- cervical incompetence, uterine anomalies
- multifetal pregnancy or previous preterm labor

Q

Prevention of Preterm Labor

tocolytics

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A

Not recommended

Managment of **Preterm Labor**

- Bed Rest - Sedatives & narcotics - Tocolytics - Corticosteroides - managment of Delivery - Neonatal Care

Managment of **Preterm Labor** - Sedatives & Narcotics

As barbiturates, diazepam & pethidine: ▪ these agents depress preterm infant when administrated to mother near time of delivery

Managment of **Preterm Labor** - Bed Rest

Preferably in Lt lateral position to improve uterine blood flow.

Managment of **Preterm Labor** - Tocolytics

Types of **Tocolytics**

- Short term - Long term

Def of **Tocolytics**

Tocolytics are drugs that inhibit uterine contractions.

Types of **Tocolytics** - Short term

Indicated to: - Delay labor 2-3 days till achieving max. effect of steroids. - Prevent preterm labor after abdominal or cervical operations or uterine manipulation.

**Tocolytics** - If pregnancy is ( ) 34 & 37 weeks

- Decision of tocolysis depends on quality of care available for premature infants & estimated fetal weight

Types of **Tocolytics** - Long term

Not effective(oral): - As they stop uterine contractions temporarily but rarely prevent preterm birth

CI of **Tocolytics**

**Tocolytics** - Drugs Used

- β-agonists - Magnesium sulfate (MgSO4) - PG synthetase inhibitors (anti-PGs) - Ca++ channel blockers (Nifedepine). - Oxytocin antagonists (atosiban) - Progesterone(17 α-Hydroxyprogesterone caproate) - Others

**Management of delivery (conduct of preterm labor)** - Place

- In well equipped hospital with availability of neonatal intensive care & neonatologist efficient in resuscitative techniques present at delivery room

**Management of delivery (conduct of preterm labor)** - Methods

**Management of delivery (conduct of preterm labor)** - Vaginal

Vaginal Delivery of **Preterm Labor** - During 1st stage

Vaginal Delivery of **Preterm Labor** - During 2nd Stage

Important precautions: - Generous episiotomy once head reaches perineum. - Outlet forceps is the only type of forceps allowable. - Ventouse is contraindicated. - No vigorous manipulations

Vaginal Delivery of **Preterm Labor** - during 3rd stage

As normal labor.

CS Delivery of **Preterm Labor**