pretem birth and prematae rptured of memb dr.nawal al sinani

is delivery befor 37 completed weeks it is the reason for 2/3 of fetal death . in first

year of live .The over all infant

mortality has continued to decline

but the mortality associated with

preterm birth is not.

Preterm birth

.

Long term out comes.The high rate of significant neonatal morbidity in these

immature neonates and diminished likelilhood of

normal life must be weighed against the apparent

triumph of survival studies showed that follow up of

neonat born at 24 -26 wks. Report that only 20% totally

free of impairment at 5 y Theye are usually has

disabilities in mental and psychomotor develapment

neuromotor function’sensory and communication function .

Economic impact.

They found that more than a1/3 of mony expended

for infant health care during the first year of life

is spent on the 7% of neonates born who weigh

less than 2500gm .additional

expenditures for developmental handicaps

during the remainder of childhood should also be

considered .

Causes of preterm birth.

Medical and obstetrical

complications.PET .

Fetal distress .

IUGR .

APH

LIFE STYLE FACTORS.

Smoking ,drug use Extreem of age

Poverty Vit c deficiency

Heavy work Long working hours.

Recurrent familial and racial nature of preterm birth has

lead to suggestion that genetics may play a causal role

Gene for decidual relaxin .

Fetal mitochondrial

trifunctional protein defects Polymorphism in the

interleukin-1 gene complex B2 adrenergic receptor

defct .

–

GENETIC FACTORS

Chorio amnionitis.

The pathway of bacteria to enter the (A.F) with

intact memb. Is unclear

E.coli can permeate living memb.

Bacterial endotoxin stimulate decidual

monocytes to produce cytokines which

stimulat arachidonic acid and prosta

glandins E2&F2 alph

Bacterial vaginosis.

Lacto bacillus ( release hydrogeen

Replaced with anaerobes

peroxide(

Periodontal disease

Oral bacteria especially

FusobacteriumIncrease the preterrm

labor by 7 fold.

Fetal fibronection

•Glycoprotein .•Releas by fetal amnion .•Present in high conc. in maternal blood

&A.F •It is thought to playaroule in placenta adhesion to the

decidua •Present of fibonectin .•In cenvico vaginal secretion prior to memb •Rupture is possible marker for impending preterm laber.•(th predictive value for the delivery . Within 1wk in 30%)

Management preterm rupture of memb .&preterm labor.

•Admission to L /R •Diagnosis of rupture memb .•Sterile speculum ex •Nitruzine test )pH of A.F 7-7.5 ( •False postive ) blood ,semen ,bacteral vaginosis (•Ferning test )Na .chlorid( •If the pt .less than34 wks •Start Antibiotic , fetal heart monitring •Beta methasone 12mg im 24 hr apart OR

dexamethasone 5mg /12hr )4doses (•

Management of preterm labor with intact memb.

•Ademissiom to L/R

•Corticosteirod therapy thyrotropin releasing hormone )enhances surfactant

synthesis( • anti micrbials)clindamycin(

•Bed rest hydration&sedation

TOCOLYTIC

B-adrenergic receptor agonists. Ritodrine

Delay deliviry for 48hrS.E ) pulmonary oedema ,hyper

glycemia ,hypokalemia ,arrhythmia, myocardial,ischemia(

Magnesium sulfateS.E ) respiratory depression ,diplopia , muscular

paralysis ,cardiac arrest ,(

.•(indomethacin ) •In hibit P.G synth .or blocking P.G action on

target organs .•S /E ) oligohy dramnios ,renal failure( •(Calcium channel blocker )•(NIFEDIPINE )•S/E )hypotension ,decrease placenta

perfusion ,fetal hyper capnia ,acidosis ,hypoxia in(

•(anti oxytocin )

TOCOLYTIC