PRETERM AND POSTTERM DELIVERY

PRETERM DELIVERY
 BACKGROUND
• Low birthweight defines neonates who are born too small
• Preterm or premature birth describes neonates who are born too
early
• Respect to size, a newborn normally grown and appropriate for
gestational age; undersized, thus, small for gestational age; or
overgrown and consequently, large for gestational age
• Those before 34 weeks are labeled early preterm, and those
occurring between 34 and 36 completed weeks are late preterm
DURATION OF PREGNANCY
 CLASSIFICATION OF PRETERM LABOR
• Extremely preterm labor
( < 28 weeks)
• Very preterm labor
( < 32 weeks)
• Early preterm labor
( < 34 weeks)
• Late preterm labor
( < 37 weeks)
 CAUSES OF PRETERM BIRTH

(1) Spontaneous unexplained preterm labor with intact membranes

(2) idiopathic preterm premature rupture of membranes (PPROM)
(3) delivery for maternal or fetal indications
(4)twins and higher-order multifetal births.
ETIOLOGY OF PRETERM LABOR
 Spontaneous Preterm Labor

• Uterine Distention
• Maternal–Fetal Stress
• Cervical Dysfunction
• Infection
 DIAGNOSIS
• Differentiation between true and false labor (Braxton Hicks)
- regularity of contractions
- rythmical contractions
• Cervical changes
- changes in concistency
- cervical effacement
- cervical dilation
 Preterm Premature Rupture of
Membranes
• Molecular Changes
- apoptosis of membrane celuller components
- collagen degradation by proteases
• Infection
- inflammation response lead to membrane weakening
- bacterial culture of amnionic fluid support of rule infections
 CONTRIBUTING FACTORS
• Pregnancy Factors
• Lifestyle Factors
• Genetic Factors
• Periodontal Disease
• Interval between Pregnancies
• Prior Preterm Birth
• Infection
NEONATAL COMPLICATIONS OF PRETERM INFANT
 Prevention

• Cervical cerclage (cervix incompetence)

• Progesteron administration
• Tocolytic only for lengthen a couple of days in order to prepare the
fetus before born (fetal lung maturation and neuroprotection)
POSTTERM DELIVERY
 DEFINITION

• Delivery more then 42 weeks of pregnancy

• Incidence 0.4 % of deliveries
Perinatal outcome associated with posterm pregnancy
 POSTMATURITY SYNDROMES
• Wrinkle, patchy and peeling skin
• Open eyed
• Alert
• Appears old and worried
• The nail are typically long
 Placental dysfuntion
• Dysfunctional syncytiotrophoblast explains the greater risks of the
postmaturity syndrome
• Placental senescence attributed the postmaturity syndrome
• The rate of placental apoptosis—programmed cell death—is
significantly greater at 41 to 42 completed weeks compared with that
at 36 to 39 weeks
• Cord blood erythropoietin levels were significantly higher in
pregnancies reaching 41 weeks or more.
 COMPLICATION

• Fetal distress
• Oligohydramnion
• Fetal growth restriction
• Macrosomia
 Antepartum management

• Induction factors
- induction of labor in favourable cervix (Bishop score)
- stripping of the membranes
• Fetal testing
- non stress test
- contraction stress test
- Biophysical Profile Test
Thank you