早产2011八年制.ppt

Zhu Jieping Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, Dept of Obs Gyn PRETERM LABOR Definition and Epidemiology Delivery occurs between 28~37 gestational weeks. Before 28 GW? ? Spontaneous labor with intact membranes ? PPROM ? Iatrogenic preterm birth 医源性早产 Elective preterm for medical indications Hypertensive diseases of pregnancy IUGR Placental abruption Nonreassuring fetal surveillance Preterm birth increases the rateof mortality and morbidity Those who survive may have medical disabilities: Respiratory distress syndrome, RDS Cerebral palsy 脑瘫 Necrotizing enteritis (坏死性小肠炎)… Risk factors Pregnancy History Previous preterm delivery Interpregnancy interval 6 months Infection Intrauterine infection, chorioamnionitis Bacterial vaginosis, Chlamydia infection (衣原体感染) Cervical Factors Shortened cervix ( 3.0 cm) History of cervical cone biopsy or LEEP(宫颈环切) Uterine Factors Uterine malformation Multiple gestation Polyhydramnios (羊水过多) Maternal medical disorders Hypertension ICP Diabetes mellitus Maternal abdominal surgery Clinical Manifestations Regular uterine contraction 30”/5~6’, or ≥ 4 times in 20 mins Effacement of cervix ≥75% Dilatation of cervix 2cm Membrane ruptures sometimes Prediction Ccervical length measurement Cut off value : 3cm Fetal fibronectin testing (fFN, 胎儿纤维连接蛋白) 胎膜分泌，粘附作用 High NPV (negative predictive value) Internal os Cervical length Head Other Examination Ultrasonography Fetus, placenta, amnion fluid Membrane rupture? How to confirm? Microbial cultivation of cervical secretion Amniotic fluid examination For what? Bacterial culture L/S ratio Foam test Management (1) AIM: To improve pediatric outcome without jeopardize maternal health. 1. To prolong pregnancy Precondition: Cervical dilation 2cm No sign of fe