Preterm Labour
by chanidapa khorsuk
1. cause
1.1. เจ็บครรภ์คลอดก่อนกำหนดเอง (Spontaneous unexplained preterm labor with intact membrane) (40-45%)
1.2. เจ็บครรภ์คลอดก่อนกำหนดตามหลังการแตกของถึงน้ำคร่ำ (idiopathic preterm premature rupture of membranes: PPROM) (30-35%)
1.3. การคลอดก่อนกำหนดโดยความจงใจชักนำคลอดเนื่องจากมีข้อบ่งชี้ (delivery for maternal or fetal indications) (30-35%)
1.4. Twins
2. risk factor
2.1. No partner
2.2. Low socioeconomic status
2.3. Depression
2.4. Abdominal surgery during pregnancy
2.5. Multiple gestation
2.6. Systemic infection, pyelonephritis, appendicitis, pneumonia
2.7. Previous preterm delivery
2.8. smoking
2.9. African-American race
2.10. Placenta previa, Placenta abruption
2.11. Poor nutrition and low BMI
2.12. Anemia (Hb<10g/dl)
2.13. Low level of education achievement
2.14. Fatal anomaly
2.15. Polyhydramnios
2.16. Uterine anomaly
2.17. Preterm PROM
2.18. History of second-trimester abortion
2.19. History of cervical surgery
2.20. Premature Cervical dilatation/effacement
2.21. STD
2.22. Vaginal bleeding
2.23. Substance abuse
2.24. Maternal age (<18 or >40)
2.25. Environment factors (eg.heat,air,pollution)
2.26. Inadequate prenatal care
2.27. Fetal growth restriction
3. complication
3.1. Respiratory distress syndrome
3.2. Bronchopulmonary dysplasia
3.3. Pneumothorax
3.4. Pneumonia
3.5. Sepsis
3.6. Patent ductus ateriosus (PDA)
3.7. Necrotizing enterocolitis (NEC)
3.8. Neurodevelopment sequelae : cerebral palsy, mental retardation, sensory impairment (visual and auditory deficit), Intraventricular hemorrhage (IVH), Periventricular hemorrhage
3.9. Behavioural sequelae : dysfunction in cognitive area and emotional control, hyperactivity disorder
4. management
4.1. term (GA ≥ 37 wk )และ Late preterm (GA 34wk – 36+6wk)
4.1.1. พิจารณาให้คลอด
4.2. Preterm (GA 24wk – 33+6wk)
4.2.1. Antibiotic to prolong latency
4.2.2. corticosteroids
4.3. Previable PROM (GA < 24 wk)
4.3.1. แนะนำผู้ป่วยเกี่ยวกับพยากรณ์ของโรค
4.3.2. Expectant management / induction of labor
4.3.3. Antibiotic
4.3.4. ไม่แนะนำให้ Tocolysis, GBS prophylaxis และ magnesium sulfate
5. Treatment
5.1. Nonpharmacologic management
5.1.1. Bed rest
5.1.2. hydration
5.2. Pharmacologic management
5.2.1. Tocolysis
5.2.1.1. ข้อห้าม
5.2.1.1.1. Intrauterine fetal demise
5.2.1.1.2. Lethal fetal anomaly
5.2.1.1.3. Severe preeclampsia or eclampsia
5.2.1.1.4. Maternal bleeding
5.2.1.1.5. Maternal contraindication to tocolysis
5.2.1.1.6. PPROM
5.2.2. Corticosteroid
5.2.3. Antibiotic