Transcript الشريحة 1

is delivery befor 37
completed weeks it is the
reason for 2/3 of fetal
death . in first year of live
.
The over all infant
mortality has continued to
decline but the mortality
associated with preterm
birth is not.
Long term out comes.
The high rate of significant neonatal morbidity in
these immature neonates and diminished
likelilhood of normal life must be weighed against
the apparent triumph of survival studies showed
that follow up of neonat born at 24 -26 wks .
Report that only 20% totally free of impairment at
5y
Theye are usually has disabilities in mental and
psychomotor develapment neuromotor
function’sensory and communication function.
Economic impact.
They found that more than a1/3 of mony
expended for infant health care during the
first year of life is spent on the 7% of neonates
born who weigh less than 2500gm .additional
expenditures for developmental handicaps
during the remainder of childhood should also
be considered.
Causes of preterm birth .
Medical and obstetrical
complications.
PET .
Fetal distress.
IUGR.
APH
Smoking ,drug use
Extreem of age
Poverty
Vit c deficiency
Heavy work
Long working hours.
GENETIC FACTORS
Recurrent familial and racial nature of preterm birth
has lead to suggestion that genetics may play a causal
role
Gene for decidual relaxin .
Fetal mitochondrial trifunctional protein defects
Polymorphism in the interleukin-1 gene complex
B2 adrenergic receptor defct.
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Chorio amnionitis.
The pathway of bacteria to enter the (A.F)
with intact memb. Is unclear
E.coli can permeate living memb.
Bacterial endotoxin stimulate decidual
monocytes to produce cytokines which
stimulat arachidonic acid and prosta
glandins E2&F2 alph
Bacterial vaginosis.
Lacto bacillus ( release hydrogeen peroxide)
Replaced with anaerobes
Periodontal disease
Oral bacteria especially
Fusobacterium
Increase the preterrm labor by 7 fold.
Fetal fibronection
Glycoprotein.
Releas by fetal amnion.
Present in high conc. in maternal blood
&A.F
It is thought to playaroule in placenta adhesion to the
decidua
Present of fibonectin.
In cenvico vaginal secretion prior to memb
Rupture is possible marker for impending preterm laber.
(th predictive value for the delivery . Within 1wk in 30%)
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Admission to L /R
Diagnosis of rupture memb.
Sterile speculum ex
Nitruzine test (pH of A.F 7-7.5 )
False postive ( blood ,semen ,bacteral
vaginosis )
Ferning test (Na .chlorid)
If the pt .less than34 wks
Start Antibiotic
, fetal heart monitring
Beta methasone 12mg im 24 hr apart OR
dexamethasone 5mg /12hr (4doses )
Management preterm rupture of
memb .&preterm labor.
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Management of preterm labor with
intact memb.
Ademissiom to L/R •
Corticosteirod therapy thyrotropin •
releasing hormone (enhances surfactant
synthesis)
anti micrbials(clindamycin) •
Bed rest hydration&sedation •
TOCOLYTIC
B-adrenergic receptor agonists .
Ritodrine
Delay deliviry for 48hr
S.E ( pulmonary oedema ,hyper glycemia
,hypokalemia ,arrhythmia, myocardial,ischemia)
Magnesium sulfate
S.E ( respiratory depression ,diplopia , muscular
paralysis ,cardiac arrest ,)
TOCOLYTIC
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(indomethacin )
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In hibit P.G synth .or blocking P.G action on •
target organs.
S /E ( oligohy dramnios ,renal failure)
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(Calcium channel blocker)
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(NIFEDIPINE)
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S/E (hypotension ,decrease placenta perfusion •
,fetal hyper capnia ,acidosis ,hypoxia in)
(anti oxytocin)
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