T

PREMATURITY POST-TERM

PREGNANCY
 Prematurety is the state of an infant born at a gestational
age less than 37 weeks
PREMATURITY
Abortion Premature labor
(earliest terms to 22 w.) (after 22 to 37 weeks)
 
Early Abortion Early Premature labor
(prior to 14 weeks) (22 – 28 weeks)
 
Latest Abortion Latest Premature labor
(29 – 37 weeks)
(14 -22 weeks)
Abortion :
► spontaneous
(without extraneous interference)
► artificial
(deliberate termination of pregnancy)
► habitual
(repetitive abortions – more than two)

Incidence - 10 – 25 % of pregnancies
ETIOLOGY :
► fetalcongenital abnormalities
► immunological disorders (Rh incompatibility etc)
► endocrine disorders
► infections (urinary tract infections, torch infection)
► extragenital diseases
► complication of pregnancy
► bad habits (drugs, smoking)
► professional risk factors
► age (younger 16 years, primigravida older 30
years)
STAGES OF ABORTION:

 I- threatened abortion
 II -imminent abortion
 III -abortion in progress
 IV - incomplete abortion
 V - complete abortion
CLINIC:
►Pain syndrome
►Bleeding

DIAGNOSTIC:
►Chief complaints
►Objective examination
►Ultrasound diagnostic
IMPORTANT – DIFFERENTIAL DIAGNOSTIC:

►1. ectopic pregnancy

►2. trophoblastic tumors
►3. uteri fibroids
►4. abnormal localization of
placentae
MANAGEMENT: IMMEDIATE HOSPITALIZATION
TREATMENT DEPENDS ON THE STAGE OF
ABORTION:

I-II stages – therapy for prevention of pregnancy

► - bed rest
► - hormonal replacement therapy (progesterone –
utrogestane, dufastone)
► - tocopherol acetate 200 mg a day
► - folic acid
► - sedative medications
► - Magne B6
► - spasmolytics
► - hemostatic
TREATMENT DEPENDS ON THE STAGE OF
ABORTION:

III-V stages:
► CURRETAGE OF UTERINE CAVITY FOR
BLEEDING TERMINATION

► ADEQUATE ANALGESIA

► ANTIBIOTICS
FOR PREVENTION OF
INFLAMMATORY COMPLICATION
ISTMICO-CERVICAL INCOMPETENCE
pathological condition deals with dilatation of
cervical canal during the pregnancy
CLASSIFICATION:
► 1. Functional (congenital)
► 2. Mechanical (due to previous trauma)
CLINIC:
► - interruption of pregnancy after 16 week
► - no bleeding or pain
► - rupture of membranes, escape of fluid
and abortion
MANAGEMENT:
TREATMENT IS SURGICAL CORRECTION OF
THE CERVIX IN TERM 11 – 16 WEEKS
METHODS: Suture on cervix by Shirodcar, Scendy

After the operation:

►absolute bed rest during few days
►special care till 36 weeks
►after 36 weeks suture is usually taken off and
spontaneous delivery will follow
CONTRAINDICATIONS:
► hard somatic diseases
► hemorrhages during the pregnancy
► inflammatory diseases of vagina
PREMATURE LABOR
STAGES:
► 1. Threatened Premature labor
► 2. Incipient Premature labor
► 2. Premature labor. in progress
CLINIC:
► Increasing of the uterine contractility
► Pain syndrome
► Hemorrhage of various significance
► Premature rupture of membranes
► Descending of fetal presenting part
► Dilation of the cervical canal

Differentiation of those stages of based on vaginal

findings
MANAGEMENT: URGENT HOSPITALIZATION

CONFIRM THE DIAGNOSIS


EVALUATE OF CERVIX

DOCUMENTAL FETAL WELL-BEING
(performing a non-stress test or contraction stress test)

ULTRASOUND, FETAL, BIOPHYSICAL PROFILE

TOCOLYSIS
PRINCIPALS OF THERAPY
 ABSOLUTE REST IN BED
 ADEQUATE SEDATION
 TOCOLYSIS:
► β2-adrernomimetics (Ginipral, Ritodrine,
Partusisten) + calcium antagonists against adverse
effects
► inhibitors of prostaglandins (Indometacine)
► Magnesium sulfate – intravenous infusion
 SPASMOLYTICS
 GLUCOCORTICOIDS – for prophylaxis of
distress syndrome
► dexamethazone 12 mg intramuscularly daily dose
(during 48-72 hours)
CONDUCTING OF PRE-TERM LABOR:
► - Prevention of early rupture of
membranes
► - Intensive fetal monitoring
► - Liberal episiotomy by pudendal
anaesthesia
► - Delivery way depends on
obstetrical situation
► - Intensive postnatal monitoring
POST-TERM PREGNANCY
Pregnancy continuing beyond two weeks of
the expected date of delivery is called as
postmaturity or post-term pregnancy
 
False Real
(anamnestical) (with clinical signs)

Incidence - 2 – 10 %
POST-TERM PREGNANCY
ETIOLOGY:
►menstrual disorders
►previous abortions
►elderly primigravidae
►nervous disease
DIAGNISIS:
► anamnesis
► objectiveexamination
► ultrasound diagnostic
► amniocentesis with cytological examination
POST-TERM PREGNANCY

CLINICAL SIGNS:
►weight loss
►loss of abdomen circumference
►obstetric palpation
►placental insufficiency “growing old”
►intrauterine hypoxia
►changing of ratio lecithin/sphingomielin

CONDUCTING OF LABOR – DEPENDS ON

OBSTETRICAL SITUATION