preterm labor-zy课件.pptVIP

Preterm labor Preterm labor(PTL): before 37 weeks’ gestation, the lower limit of gestation is not uniformly defined.(20w) In our country :before 37 and after 28 weeks’ gestational age(196-258days), fetal weight 1000~2499g Take up 5-15% of all pregnancy significant cause of perinatal morbidity and mortality ARDS, necrotizing enteritis , Hyperbilirubinemia, cerebral palsy Iatrogenic spontaneous Cause of PLT is not unknown .Multifactorial High risk factors: 1.PROM Chorioamnionitis(30%~40%) 2.Infection of lower genital tract and/or urinary tract BV ,beta-haemolytic streptococcus , chlamydia, mycoplasma Acute pyelonephritis, asymptomatic bacteriuria or recurrent urinary tract infection 3. Pregnancy complications Pre-eclampsia,ICP,antepartum haemorrhage Etiology 4.Medical and surgical illness diarrhoea ,acute appendicitis,abdominal operation, chronic diseases:hypertension,nephritis,heart disease,severe anaemia 5.Overexpansion of uterus Polyhydramnios ,Multiple pregnancy 6.Placeta Placenta previa,Placental abruption,infarction or thrombosis Etiology 7.Malformation of uterus Bicornuate, unicornuate uterus,subseptate 8.Cervical incompetence 9.others History of abortion(induced or spontaneous) or preterm delivery Smoking habits,alcoholism Maternal trauma Low socio-economic and nutritional status Low body mass index etc. History :late abortion、preterm labor、birth injury Time:before 37 and after 28 weeks’ gestational age(196-258days) Symptoms:regular uterine contraction,every 5-6minutes once,last 30seconds or more Signs: effacement and dilatation of cervix Others:vaginal bleeding or fluid in it Before 37 and after 28 weeks’ gestational age(196-258days) Regular contraction: ≥4times(20minutes) or ≥8times(60minutes) Cervical effacement ≥75%, dilatation 2cm it is better to overdiagnose preterm labor than to ignore the possibility of its presence Diagnosis Prediction of preterm labour (1)Transvaginal ultrasound Cervical leng