产科学英文课件：16 早产 preterm birth.ppt

Shanghai Jiao Tong University 早产 Preterm Labor To review the Definition, frequency and consequence of preterm delivery High risks for Preterm delivery Pathogenesis of Preterm delivery Prediction of Preterm delivery Management of Preterm labor Objectives Definition Preterm labor PTL is also called premature delivery and can lead to an early birth. PTL is defined as: labor and delivery between 28-36+6 weeks; Incidence: 5-15%; Birthweight:1000 - 2500 grams Preterm birth: 37completed weeks Very Preterm birth: 32 weeks Extremely Preterm birth: 28 weeks 1、About a quarter of preterm births are planned. 2、The rest are known as spontaneous preterm births. Death, severe neonatal morbidities Common before 26 weeks Universal before 24 weeks Worse Outcomes: ARDS ——chronic lung disease brain hemorrhage Threshold for neonatal mortality: 1600g Threshold for neonatal morbidity: 1900g Cause of Preterm Labor Decidual hemorrhage (eg, uterine overdistention from multiple gestation or polyhydramnios) Cervical incompetence (eg, trauma, cone biopsy) Uterine distortion (eg, müllerian duct abnormalities, fibroid uterus) Cervical inflammation (eg. bacterial vaginosis (BV) ) Maternal inflammation/fever (eg, urinary tract infection) Hormonal changes Uteroplacental insufficiency (eg, hypertension, insulin-dependent diabetes, drug abuse, smoking, alcohol consumption) Prediction of Preterm Delivery History: Current and Historical Risk Factors Mechanical Uterine contractions uterine activity monitoring Biochemical Fetal fibronectin Ultrasound Cervical length 25mm Fetal fibronectin (fFN) a fibronectin protein produced by fetal cells; found between the fetal sac and the uterine lining; be thought of as an adhesive or biological glue that binds the fetal sac to the uterine lining; Fetal fibronectin vs. Clinical assessment of Preterm Labor Parameter Sensitivity (percent) PPV (percent) NPV (percent) Fetal fibronectin