PRETERM
NEONATE
Outline
Objectives
Definition
Epidemiology
Etiology
Risk of prematurity
Diagnosis
Clinical findings
Management
Objectives
At the end of this session the student will be
able to:
Define preterm birth.
Describe the epidemiology of preterm birth.
List the etiology of pre term birth.
State the risk of pre term birth.
Explain the diagnosis of preterm birth.
List clinical findings of preterm birth.
Describes management of preterm birth.
DEFINITION
A preterm birth is defined
as one that occurs before
the completion of 37
menstrual weeks of
gestation, regardless of
birth weigh.
OR
Cont…..
Preterm: is pregnacy
from 28 to less than 37
completed weeks ( less
than 259days). If is
currently extended from
20th week to less than 37
completed weeks ( less
than 259 days)
Epidemiology
o Preterm birth is among the top causes of death in infants
worldwide.
o It complicates 10–15% of all pregnancies.
o The main burden of preterm birth exists in developing
countries
o Preterm labor accounts 5% in developed countries & 25% in
developing countries.
o preterm birth rate is higher in black than white women.
Cont…
1. “Spontaneous” preterm birth. Seventy-fi
ve percent of preterm births occur
spontaneously after preterm labor and preterm
premature rupture of membranes (PPROM).
2. “Indicated” preterm birth. Twenty to thirty
percent of all preterm births occur because
of a
medical or obstetric disorder that places the
mother or fetus at significant risk for serious
morbidity or mortality.
3. Neonatal morbidity and mortality increase
as the gestational age at delivery decreases
Aetiology
(I) Maternal causes:
(1) Medical disorders:
Preeclampsia.
Chronic nephritis.
Anaemia and malnutrition.
(2) Antepartum haemorrhage:
Placenta praevia,
Abruptio placentae.
(3) Uterine anomalies:- Septate uterus.
Incompetent cervix.
Fibroid uterus.
(4) Psychological or hormonal
Cont…
(II) Foetal causes:
1- Congenital anomalies.
3- Polyhydramnios.
4- Multiple pregnancy.
5- Rh- isoimmunization.
6- Premature rupture of membranes.
(III) Idiopathic
Risk of Prematurity
(1) Birth trauma: particularly
intracranial haemorrhage which is
aggrevated by
hypoprothrombinaemia and capillary fragility
present in prematures.
(2) Respiratory distress syndrome (RDS):
occurs due to deficient pulmonary surfactant
which helps distension of the alveoli.
A structureless hyaline membrane will
develop within the alveolar ducts and
atelectasis of the alveoli occurs.
Cont ….
Dyspnoea and cyanosis develops
1-2 hours after delivery and death
occurs after about 30 hours.
RDS is seen also in infants;
- to diabetic mothers,
- delivered by caesarean
sections ,or
Treatment: oxygen and 8.4 % sodium
- had intrapartum
bicarbonate asphyxia
infusion to .
combat acidosis
Cont…..
(3) Hypothermia as a result
of:
i) Decreased heat production due to;
- reduced muscle activity and -
hypoglycaemia.
ii) Increased heat loss due to;
- large surface area relative to
body weight,
- lack of insulating fat,
(4) Infection especially
respiratory due to:
i) immaturity of the immune
mechanism,
ii) susceptibility of the delicate
tissues to trauma.
(5) Haematological disorders:
i) Anaemia due to :
- impaired haemopoiesis,
- increased RBCs destruction,
- poor iron stores in the liver which are filled in
the last weeks of pregnancy
ii) Hypoprothrombinaemia: due to liver
immaturity this is in addition tocapillary
fragility increase the liability for haemorrhage.
iii) Hyperbilirubinaemia due to:
- liver immaturity and - increased RBCs
destruction
(6) Malnourishment due to:
weak suckling, and.
weak digestion
liver immaturity
Rickets and impaired mental
development occurs more
frequently in children who were
prematures
Diagnosis During Labour
(1) Uterine contractions of :
a- frequency every 10 minutes or less,
b- duration at least 30 seconds and
c- continue for at least one hour.
(2) Uterine contractions of whatever the
frequency and duration but with:
a- rupture membranes,
b- effacement 75% or more, or
c- cervical dilatation 3 cm in primigravida
and 4 cm in multigravida.
Clinical Findings During Labour
Sign & symptoms
Uterine Contractions
Dilatation and Effacement of Cervix
Vaginal Bleeding
Laboratory studies
CBC with differential
urinalysis, culture, and sensitivity testing.
Ultrasound examination for GA
Amniocentesis –for lung maturity & bacteriological study
Management For preterm
Neonate
1. Air way: suction and oxygen if needed.
2. Incubation: is indicated if the birth weight is
less than 2.5 kg.
a- The baby is placed on his side with the head
slightly lower
down.
b- Temperature of the incubator is between 32-
36oC.
c- Humidity of 70%,
d- Oxygen concentration not more than 30% to
avoid retrolental
fibroplasia and blindness.
Cont ….
3- Antibiotics : prophylactic
antibiotic as ampicillin to protect
against infection.
4- Feeding : Breast milk is given as
normal if the baby can suck,
otherwise the expressed milk can
be given by a dropper, spoon or
nasogastric tube.
Cont ….
5- Vitamins and iron:
a- Vitamin K1mg IM is given to
the neonate if it was not given
to the mother during labour.
b- Iron and vitamins : can be
given at the age of 2-3 weeks.
:
Preventive management
The aim is to inhibit labour till completed
37 weeks’ gestation or at least till the
foetal lung maturity is ensured .
This may be achieved by acting on one or
more of the
following theories of labour.
(I) Neuromuscular:
1. Sedation: as diazepam.
3. b - Sympathomimetic drugs: as ritodrine
and isoxuprine.
4. a - receptor blockers: as
Cont……
(II) Hormonal :
1- Betamethazone:
4 mg betamethazone IM every 8 hours for 48
hours can cause:
- decrease oestrogen synthesis by
depressing the production of its precursor
from the foetal adrenal gland.
- inhibition of prostaglandin synthesis.
- acceleration of foetal lung maturity.
2-Prostaglandin inhibition: e.g.
endomethacin.
3-Oxytocin inhibition
Cont…..
(III) Mechanical:
Rest in bed: to reduce the mechanical stimuli from the
pressure of the presenting part on the lower uterine
segment.
Cervical circulage: it is of value in prevention of
abortion and preterm labour if done at 14-16 weeks’
gestation but not so later on.
Amniocentesis: was advocated by some authors to
reduce the mechanical distension of the uterus in
polyhydramnios.
The drainage should be slowly aspirating 1 litre of amniotic
fluid over 3-4 hours as sudden drop of uterine volume may
initiate uterine contractions and causes abruptio placentae.
Classification of preterm
1.<32Wks=Very premature
2.32~34Wks=Premature
3.34~37Wks=Late
premature
THANK YOU FOR
YOUR
ATTENTION
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