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Introdution
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Pathophysiology
Infection
Intra-uterine
* Ascending (from genital tract)
* Transplacental (blood-borne)
* Transfallopian (intraperitoneal)
* Iatrogenic (invasive procedures)
Extra-uterine
* Pyelonephritis
* Malaria
* Typhoid fever
* Pneumonia
* Listeria
* Asymptomatic bacteriuria
In:Jane Norman.Preterm labor 2005
Over distension
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Mu tion lyhyd
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Vascular ( uteroplacental
disturbance )
Pyelonephritis
Appendicitis
Cholestasis
Pneumonia
Amniocentesis
Cervical weakness
Risk Factors
Diagnosis
History
Examination
Investigations
History
Ask about pain/contactionsonset frequencyduration-severity.
Vaginal loss : SROM or PV bleeding
Obstetric History
Examination
Maternal pulse tempreture respiratory r
ate.
Uterine tenderness ( abruption infections)
Fetal presentation
Speculum : look for blood,discharge,liquor.
Take swaps .
Gentle VE
Investigations
FBC
Swabs
MSU
USS for fetal presentation age
Fetal fibronectin TVS if available
Management
Theartend or real Labour
(TVS cervical >15mm Neg fibronectin a
ssay )>> unlikely to be labour .
Admision if high risk & inform neonatal unit
Arrange in utero transfer
Check fetal presentation by US
Steriods
Prevention
Rx of bacterial Vaginosis
Progesterone
Cervical cerclage
Cervical pessary
Reduction of selective number of pregnan
cy
Premature of membrane
Definition
Incidence
PROM occurs in about 1/3 of preterm deliv
eries.
1/3 caused with other infections
Cause of PROM(1)
Cause of PROM(2)
Cause of PROM(3)
Experimental Test(1)
The Nitrazine test uses pH to distinguish amniotic fluid fr
om urine and vaginal secretions, the paper turns dark blu
e in response to the amniotic fluid
Amniotic fluid is quite alkaline having a pH above 7.0, but v
aginal secretions in pregnancy usually have pH values of
less 6.0
Experimental Test(2)
Risk of PROM
Preterm labor: 75%
Intrauterine infection(chorioamnionitis, 3050% of case)-( maternal fever abdominal pain offensive
discharge tachytracia)
Puerperal infection
Evaluation
The gestational age( LMP, ultrasound and uterus fundal height meas
urement)
The presence of uterine contractions (abdominal examination)
The amount of amniotic fluid (ultrasound)
Fetal heart rate (FHR monitor)
Fetal maturity (L/S or PG)
The likelihood of chorioamnionitis (white blood cell count)
The likelihood of prolapse of umbilical cord
Management
Thank You