4. Significance
Preterm birth is the leading direct cause of neonatal death
(death in the first 28 days of life).
It is responsible for 27 percent of neonatal deaths
worldwide, comprising over one million deaths annually
The risk of neonatal mortality decreases as gestational age
at birth increases, but the relationship is nonlinear (figure 1
preterm birth is the second most common cause of-death
(after pneumonia) in children younger than 5 years.
5. Survival in Premature Infants
survival chance is directly proportional to the maturity
26 wks – 80%
27 wks – 90%
28-31 wks – 90 to
95%
32-33 wks – 95%
34-36 wks –
approaches term
survival rates
8. Prevalence
Worldwide
11 percent (range 5 percent [parts of Europe] to 18 percent
[parts of Africa]),
15 million children each year (range 12 to 18 million)
United States in 2011, 11.73 percent
19. Signs and symptomsSigns and symptoms
1. Painful or painless uterine contractions
2. Menstrual-like cramping
3. Mild, irregular contractions
4. Low back ache
5. pressure sensation in the vagina
6.6. Vaginal dischargeVaginal discharge of mucus, which may
be clear, pink, or slightly bloody (ie,
mucus plug, bloody show)
21. Initial evaluation
Maternal vital signs:
(temperature, blood pressure, heart rate, respiratory rate)
Fetal monitoring:
fetal heart rate and contraction (frequency /duration /intensity)
Uterine contractions are evaluated continuously using a contraction
monitor, palpation, and the patient’s subjective assessment.
patient’s past and present obstetrical and medical history and GA
Examination of the uterus
firmness, tenderness, fetal size, and fetal position.
22. Initial evaluation
Speculum examination
using a wet non-lubricated speculum
cervical dilation and effacement
uterine bleeding (abruptio placenta or placenta previa)
fetal membranes, ( intact or ruptured)
fetal fibronectin (fFN).
bactrial culture (B streptococcal,gonorrhea and chlamydia)
23. Fetal Fibronectin
Fetal Fibronectin (fFN)- it is a glue like protein
binding choriodecidual membrane
Present in vaginal secretions between 23-34 weeks
and signifies onset of labor
Bedside test can be done – if negative it rules out
preterm labor in next two weeks
P/V examination gives false positive result for 24
hours
Between 24-32 weeks
fFN – 25ng/ml + cervical length of 25 mm
shows significant risk
24. Initial evaluation
Ultrasound examination
Assess amniotic fluid index.
Determine (+/ - 3 weeks) gestational age.
Transvaginal scan for cervical length.
Normal cervical length = 35 mm
Significant cervical length = 25 mm
Funnelling of membrane
25. Management
1. BBetamethasone (24- 34w)etamethasone (24- 34w)
2.2. Tocolytic drugs (before 34w)Tocolytic drugs (before 34w)
for up to 48 hours
3.3. AntibioticsAntibiotics ( GBS chemoprophylaxis, Appropriate
antibiotics to women with positive urine culture results)
Bed rest (+)
Hydration (-)
Emergency cerclage (+)
26. Glucocorticoid
BetamethasoneBetamethasone
12mg IM stat and 24 hours later
Effective: 24 hours after initial dose
Effect up to 7 days
Adverse effect:
Pulmonary edema
Infection
Difficult glucose control in DM women