Preterm Labour.pptx basic etiology clinical presentation

Good basic etiology

1. Mr. Lasgih Musukuma Maimba Dip CM, BSc CS, MSc IHPE student 28/06/2022 LMMU Preterm labour (Premature Labour) for COG 1 MAIMBA 2022

2. Objectives By the end of the session student should be able to: Definition Preterm Labour Know the Risk/predisposing factors Know the Clinical Presentation Investigate and Diagnose of a patient in preterm Understanding and know the management of preterm labour MAIMBA 2022 2

3. Outline Introduction Definition Risk factors Clinical Presentation Investigation and Diagnosis Management Complication Summary MAIMBA 2022 3

4. Introduction Preterm birth is the leading cause of perinatal and neonatal morbidity and mortality MAIMBA 2022 4

5. Definitions Preterm Labour (According to WHO) Onset of Labour after gestation of viability and before 37 complete weeks or 259days of pregnancy.

6. Definitions Preterm Birth Spontaneous or iatrogenic delivery before 37weeks gestation Incidence: 7-12 %

7. Risk Factors Multiple Pregnancy 50% Uterine Anomaly 50% Previous history of preterm delivery 25% Preeclampsia APH Other Risk Factors PPROM Smoking Short cervix Genital/ Urinary tract infection

8. Classification MAIMBA 2022 8

9. Clinical Presentation Lower abdominal pressure Back pain Per vaginal Discharge Uterine contraction at least 3/30min Gestation Age 24 to 36 wks Cervical Dilatation ≥ 2cm or Cervical Changes

10. Prediction of PTL No available routine screening test However: Previous HX Bacterial Vaginosis U/S measurement of Cervical length (<2.5cm by 24weeks). Fetal Fibronectin: Fibronectin is a glycoprotein that binds the fetal membrane to the decidua.

11. Prevention of PTL Cerclage in at risk women Rescue cerclage For women between 16+0 and 27+6days Progesterone Anti-inflammatory action counteract inflammatory process that initiate labour Decrease conduction of contraction Number of oxytocin receptors reduced

12. Management of Acute PTL Role of Tocolysis in modern practice In utero transfer Await administration of antenatal steroids Reduce the number of deliveries within 48hours to within 7days of commencing the drugs

13. Contraindication to PTL Tocolysis Obstetric Severe abruption PROM Chorioamnionitis

14. Contraindication to PTL Tocolysis Fetal Lethal anomaly e.g. renal agenesis, anencephaly Fetal jeopardy e.g. Severe late decelerations IUFD Maternal Severe pre eclampsia Severe PIH Advanced dilatation

15. Tocolytic Agents Magnesium Sulfate (MgSO4) Competes with Calcium (Ca) Toxicity : Muscle weakness, Respiratory depression Rx: Calcium Gluconate Calcium Channel Blockers Reduce intracellular Ca e.g. Nifedipine Toxicity : Tachycardia, Hypotension, Myocadial depression

16. Tocolytic Agents 3. Beta Agonists-block B2 receptors e.g. Ritodrine Toxicity: Hypokalemia, Hyperkalemia 4. Prostaglandin (PG) Synthatase Inhibitors, ↓PG e.g. Indomethacin Toxicity: Oligohydramnios, Patent Ductus Arteriosus closure 5. Oxytocin Antagonists e.g. Atosiban

17. Corticosteroid Therapy Betamethasone 12mg/24hours IM X 2 doses Dexamethasone 6mg/12hourly IM X 4 doses NB: Beneficial when the delivery is delayed beyond 48hours Benefits persist up to 18days ↓RDS, ↓ Necrotizing enterocolitis, ↓ IVH

18. Conduct of PTL Deliver at Facility with NICU Avoid Extra-utero transfer Cervical, urine cultures Computer Tomography (CTG) when labour established Vaginal delivery when head is Cephalic Mode of breech Delivery is individualized

19. Neonatal Outcomes of PTL RDS Hypothermia Hypoglycaemia Electrolyte Imbalance Retinopathy Neurodevelopmental Problems