Preterm labor

1. Preterm laborPreterm labor
By: Dani Mamo
Aws Nabeel
Umed Muayad
( 4th
course , 8th
semester )

2. This presentation is about preterm
labor and contain many short topics
and prepared by 4th
course student of
ivane javakhichvili tbilisi state
university .
this presentation is prepared by
Dani Mamo , and
the questions are prepared by Aws
Nabeel and Umed Muayad.

3. What is preterm labor?
• Preterm labor is defined as regular
contractions of the uterus resulting in changes
in the cervix that start before 37 weeks of
pregnancy. Changes in the cervix include
effacement (the cervix thins out) and dilation
(the cervix opens so that the fetus can enter
the birth canal).

4. • by WHO is defined as Onset of labour prior to
the completion of 37 weeks of gestation, in a
pregnancy beyond 20 weeks of gestation.
• preterm birth: when birth occurs between 20
weeks of pregnancy and 37 weeks of
pregnancy, it is called preterm birth.

5. • If uterine contractions are perceived in the
absence of cervical change, the condition is
called Threatened Preterm Labour. This
condition tends to be over diagnosed and
over treated.Nearly 50-60% of preterm births
occur following spontaneous labour. 30% due
to preterm premature rupture of membranes
Rest are iatrogenic terminations for maternal
or fetal benefit.

6. Why is preterm birth a concern?
• Preterm birth is a concern because babies
who are born too early may not be fully
developed. They may be born with serious
health problems. Some health problems, like
cerebral palsy, can last a lifetime. Other
problems, such as learning disabilities, may
appear later in childhood or even in
adulthood.

7. Incidence
• Preterm birth occurs in 5-12% of all pregnancies
and accounts for majority of neonatal deaths and
nearly half of all cases of congenital neurological
disability, including cerebral palsy. A neonate
weighing 1000- 1500 g today has ten times
greater chance of surival then what it had in
1960s.The focus is hence shifting to early
preterm births(<32 weeks) which account for 1-
2% of all births but contribute to 60% of perinatal
mortality and nearly all neurological morbidity.

8. the risk of health problems
• The risk of health problems is greatest for
babies born before 34 weeks of pregnancy.
But babies born between 34 weeks of
pregnancy and 37 weeks of pregnancy also
are at risk.

9. Risk factor
• Having a previous preterm birthHaving a short
cervixShort interval between
pregnanciesHistory of certain types of surgery
on the uterus or cervixCertain pregnancy
complications, such as multiple pregnancy and
vaginal bleedingLifestyle factors such as low
prepregnancy weight, smoking during
pregnancy, and substance abuse during
pregnancy

10. Sign and symptoms
1- Change in type of vaginal discharge (watery, mucus,
or bloody)
2- Increase in amount of discharge
3- Pelvic or lower abdominal pressure
4- dull backache
5- Mild abdominal cramps, with or without diarrhea
6- Regular or frequent contractions or uterine
tightening, often painless
7- Ruptured membranes

11. Tests and diagnosis
• Pelvic exam
• Ultrasound
• Uterine monitoring
• Lab tests
• Maturity amniocentesis

12. • Pelvic exam : the health care provider might
evaluate the firmness and tenderness of the
uterus and the baby's size and position. pelvic
exam is to determine if the cervix has begun
to open — if the water hasn't broken and the
placenta isn't covering the cervix (placenta
previa).

13. • Ultrasound: An ultrasound might be used to
measure the length of the cervix and
determine a baby's size, age, weight and
position in the uterus. and might need to be
monitored for a period of time and then have
another ultrasound to measure any changes in
the cervix, including cervical length.

14. • Uterine monitoring: the health care provider
might use a uterine monitor to measure the
duration and spacing of the contractions.

15. • Lab tests: the health care provider might take
a swab of the vaginal secretions to check for
the presence of certain infections and fetal
fibronectin ( a substance that acts like a glue
between the fetal sac and the lining of the
uterus and is discharged during labor).
However, this test isn't reliable enough to be
used on its own to assess the risk of preterm
labor.

16. • Maturity amniocentesis: the health care
provider might recommend a procedure in
which amniotic fluid is removed from the
uterus (amniocentesis) to determine the
baby's lung maturity. The technique can also
be used to detect an infection in the amniotic
fluid.

17. Treatment
• For some women, a surgical procedure known
as cervical cerclage can help prevent
premature birth. During this procedure, the
cervix is stitched closed with strong sutures.
Typically, the sutures are removed when the
baby is considered full term — during week 37
of pregnancy. If necessary, the sutures can be
removed earlier.

18. • Cervical cerclage might be recommended if
she is less than 24 weeks pregnant, and she
had a history of early premature birth and an
ultrasound shows that the cervix is opening or
that the cervical length is less than 25
millimeters.

19. • Corticosteroids: if the period is between
weeks 24 and 34, the health care provider
might recommend an injection of potent
steroids to speed the baby's lung maturity.
After week 34, the baby's lungs might be
mature enough for delivery without steroids.

20. • Magnesium sulfate: Although this medication
isn't likely to prolong the pregnancy, some
research has shown that it may reduce the
risk of a specific type of damage to the brain
(cerebral palsy) for babies born before 32
weeks of gestation.

21. • Tocolytics: is used to temporarily stop the
contractions.

25. Dani mamo