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PTL (Pre-Term- Labour )

PTL (Pre-Term- Labour ). Objectives. Definition Epidemiology Risk factors Screening Diagnosis Prevention Management. Definition.

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PTL (Pre-Term- Labour )

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  1. PTL (Pre-Term-Labour)

  2. Objectives Definition Epidemiology Risk factors Screening Diagnosis Prevention Management

  3. Definition The occurrence of regular uterine contraction associated with cervical changes (dilation and effacement) after the age of viability and before 37 completed weeks from LMP. Means ? Different from threatened PTL ?

  4. Epidemiology PTB is the leading cause of fetal morbidity and mortality PTB is increasing in incidence by US statistics from 11% to 12% in the last 5 years PTB accounts for about 85% of peri-natal morbidity and mortality 2/3rd of PTB associated with PROM

  5. Risk Factors Maternal-related : Age: lowest incidence in 25-29 years Race: 2x in blacks Weight: 3x more if < 50 kg Increases with smoking , alcohol , coitus

  6. Risk Factors Previous History: History of abortions Uterine abnormalities Previous pregnancy bleeding

  7. Risk Factors Present complications: Uterine over distention Congenital abnormalities Threatened abortion Maternal illness * IUCD Genital tract infection *

  8. Screening The most comprehensive and used tests: Fetal FibronectinTesting Cervical sonographicasseements Some about comp ?

  9. Fetal Fibronectin Testing Produced from disruption of chorio-decidual structure in these circumstances: Pre-term labour Infection Stress&hemmorhage When its +ve this increases the risk of PTL Helpful in ? Not in JUH ..

  10. Cervical sonographicassesments • High sensitivity • High positive predictive value ? Compare with FF • The whole aim is to check the cervical length: • If the cervix length is less than/equal 1.5 cm there is high risk of pre-term labour

  11. Diagnosis The criteria for diagnosis : Regular uterine contractions 4 contractions in each 20 minutes 2. Cervical changes Dilatation >= 2cm Effacement > 80% In threatened PTL only one of the above presents

  12. Prevention Cevicalcerclage Progestrone Detection and treatment of vaginal and intrauterine infection NSAIDS

  13. Management The whole aim is to stop labour so the contraindications to management and inhibition of labor : Absolute: Fetal death Chorioamnionitis Fetal / Maternal indication

  14. Relative: IUGR Pre-eclampsia Vaginal bleeding Cervial dilatation > 4cm To sum up ?

  15. Tocolytic agents B-agonist Prostaglandins synthetase inhibitor Mgso4 * Calcium channel blocker * Oxytocin antagonist - Atosiban

  16. Mgso4 Dose: 5-8 mg/dl Side effects: Respiratory depression Decrease temperature Flushes Monitoring: RR Deep tendon reflexes Urine output Blood level

  17. Mgso4 Good To Know: Has a neuro-protective effect against cerebral palsy so it’s the becoming leading drug in the treatment of PTL

  18. Glucocorticoids Promotes the release of surfactant from type 2 pneumocytes Effect last for one week Don’t give multiple courses

  19. New Study Don’t give antibiotics in PTL without PROM The incidence of cerebral palsy increases with the use of erythro/clindamycin as estimated by the ORACLE 2 study .

  20. FINITO Done by Ala’ Hawwa

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