preterm of labor and birth.ppt

7/25/2019 PRETERM OF LABOR AND BIRTH.ppt

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Alexandra Niken Larasati

FK UKI 0861050024


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A birth at less than 245 days after conception, or, by menstrual dating, ator after 20 and before 37 weeks (25 days! of gestation from the first dayof the last normal menstrual period, is commonly defined aspreterm orpremature"

#irths at or after 37 0$7weeks are considered to be term" %nfants who

weigh less than 2500g at birth, regardless of gestational age, aredesignated as low birth weight ('!" %nfants who weigh less than 500gare called )ery low birth weight (*'!, and those below 000g aree+tremely low birth weight ('!"

-reterm and ' infants ha)e in the past been considered together, butad)ances in the accuracy of pregnancy dating increasingly allow

outcomes related to gestational age to be distinguished from outcomesrelated to birth weight" .his is important, because perinatal and infant morbidities )ary

substantially according to age and maturity as well as weight"4 /bstetricdata are reported by gestational age" .raditionally reported by birth

weight, newborn and infant data are increasingly described by gestationalage as well"


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Births before ! "eeks in the United #tates in$reasedann%all& fro' ()4* in 1(80 to a +eak of 12)8* in 2006)

,he rate has sin$e fallen ea$h &ear to -%st %nder 11)((* in2010) .reli'inar& data fro' 2011 sho" a f%rther de$line to

11)!2* /Fi) 401)


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3ore than !0* of +reter' births o$$%r bet"een 4 and

6 "eeks /Fi) 402)


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Altho%h these late +reter' infants ex+erien$e sinifi$ant 'orbidit& 'ost

+erinatal 'ortalit& and serio%s 'orbidit& o$$%rs a'on the 16* of +reter'

infants /)5* of all births "ho are born before 2 "eeks estation

$o''onl& $alled very preterm births (Fig. 40-3).


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.reter' birth has been $alled '%ltifa$torial be$a%se ofthe n%'ero%s obstetri$ and 'edi$al $onditions thata$$o'+an& it)

,raditional obstetri$ taxono'& has not distin%ished the$lini$al +resentations of +reter' +art%rition /e))+reter' labor +.73 $er9i$al ins%ffi$ien$& fro'$a%sati9e 'e$hanis's s%$h as infe$tion he'orrhae%terine distention tra%'a or fetal $o'+ro'ise or fro'risk fa$tors /e)) '%lti+le estation +rior +reter' birth+ree$la'+sia abr%+tio +la$entae +la$enta +re9ia fetal

ro"th restri$tion 'aternal diabetes h&+ertension+&elone+hritis)


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PERINATAL AND INFANT MORTALITY

.reter' birth is the leadin $a%se of +erinatal and infant 'ortalit& for infants bornto "o'en of all ra$es and ethni$ ba$kro%nds and +arti$%larl& for non:is+ani$bla$k "o'en) ,heperinatal mortality rate is defined in two ways according to thebo%ndaries of the fetal and neonatal data re+orted)

.erinatal definition I begins with fetal deaths at 28 weeks of gestation andetends to infant deaths at less than age ! da"s) .erinatal definition II is #o$ein%l&si'e( in%l&ding all fetal deaths at 2) weeks* gestation o$ #o$e and all infantdeaths less than age 28 da"s) ,he deno'inators for both +erinatal rate$o'+%tations are +er 1000 li9e births and fetal deaths for their respective time+eriods)

.erinatal definition I is 'ost %sef%l "hen data are $o'+ared bet"een states"hereas definition II 'ore a$$%ratel& re+resents the $o'bined effe$ts of +renatalintra+art%' and neonatal $are) ,he infant mortality rate is the number of deathsof liveborn infants before 1 &ear of ae +er 1000 live births; stillbirths are notin$l%ded in the deno'inator) 7ates of fetal +erinatal and infant 'ortalities ha9ede$lined sin$e 1((02 /Fi) 405)

Fetal deaths a$$o%nt for 'ore than half of +erinatal deaths and are al'ost asfre;%ent as infant deaths) In 2005 there "ere 258(4 fetal deaths /51)6* bet"een20 and 2! "eeks and 48)!* after 28 "eeks and 18!82 neonatal deaths /!()(*before ! da&s and 20)1* bet"een ! and 28 da&s after birth /Fi) 406


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+estational Age

es+e$iall& bet"een 22 and 2 "eeks

,i$th -eight


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Bleedin

3%lti+le ?estational

Uterine


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#&'+to's and #ins

.reter' labor '%st be $onsidered "hene9er abdo'inal or +el9i$ s&'+to'so$$%r after 16 "eeks estation)

+el9i$ +ress%re in$reased 9ainal dis$hare ba$ka$he and 'enstr%allike$ra'+s o$$%r $o''onl& d%rin nor'al +renan$& and the& s%est

+reter' labor 'ore b& their +ersisten$e than their se9erit&)

@ontra$tions 'a& be +ainf%l or +ainless de+endin on the resistan$e offeredb& the $er9ix)

A$$%rate dianosis of earl& +reter' labor is diffi$%ltbe$a%se the s&'+to's and sins of +reter' labor o$$%r

$o''onl& in nor'al "o'en "ho do not deli9er beforeter' and be$a%se diital exa'ination of the $er9ix inearl& labor /at $' dilation and 80* effa$e'ent is nothihl& re+rod%$ible)


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Regionali.ed /a$e

:os+itals and birth $enters $arin for nor'al 'others and infants are

desinated le9el I)

Larer hos+itals that $are for the 'a-orit& of 'aternal and infant

$o'+li$ations are desinated le9el II $enters these hos+itals ha9e neonatalintensi9e $are %nits staffed and e;%i++ed to $are for 'ost infants "ith birth

"eihts reater than 1500)

Le9el III $enters t&+i$all& +ro9ide $are for the si$kest and s'allest infants

and for 'aternal $o'+li$ations re;%irin intensi9e $are)


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#trateies to red%$e 'orbidit&

- Antenatal Corticosteroids

Antenatal $orti$osteroids +ro'ote 'at%ration o9er ro"th of the de9elo+in

fet%s) In the l%n $orti$osteroids +ro'ote s%rfa$tant s&nthesis in$rease l%n

$o'+lian$e red%$e 9as$%lar +er'eabilit& and i'+ro9e the +ostnatal

s%rfa$tant res+onse) Also antenatal $orti$osteroids ha9e si'ilar 'at%rational

effe$ts on other orans in$l%din the brain kidne&s and %t)

3ore re$entl& $lini$al trials s%++ort the notion that ad'inistration of a sinle

res$%e $o%rse of steroids before "eeks i'+ro9es neonatal o%t$o'e /e))

de$reased res+irator& distress s&ndro'e 9entilator s%++ort and s%rfa$tant

%se "itho%t an a++arent in$rease in shortter' risk) A res$%e $o%rse 'a& be$onsidered if the initial treat'ent "as i9en 'ore than 2 "eeks before and if

the estational ae is less than 2 6! "eeks in a "o'an -%ded to be at risk

for i''inent deli9er&)

0owe'e$( $eg&la$l" s%hed&led $e1eat %o&$ses o$ #&lti1le %o&$ses #o$ethan two3 a$e not $e%o##ended4


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,o$ol&ti$ ,hera+&

Be$a%se the $ontra$tin %ter%s is the 'ost easil& re$oniCed ante$edent of

+reter' birth sto++in $ontra$tions has been the fo$%s of thera+e%ti$

a++roa$hes) ,his strate& is based on the nai9e ass%'+tion that $lini$all&

a++arent $ontra$tions are $o''ens%rate "ith the initiation of the +ro$ess of

+art%rition b& loi$al extension s%$$essf%ll& inhibitin $ontra$tions sho%ld

+re9ent deli9er&)

,he inhibition of '&o'etrial $ontra$tions is $alled to$ol&sis and an aent

ad'inistered to that end is referred to as a to$ol&ti$


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N%'ero%s trials of 9ario%s aents /lo"dosae as+irin antioxidant 9ita'ins @ and >and fish oil ha9e been $ond%$ted to testtheir effe$ts on the rates of +ree$la'+siafetal ro"th restri$tion and +reter' birth)

Antenatal @are

preterm of labor and birth.ppt

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