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"Pre-term Labour, PPROM, PROM, Prlonged Pregnancy" by Abdallah Badaha

How To Diagnose Pre-term Labour, PPROM, PROM, Prlonged Pregnancy??!

Abdallah Badaha

on 7 June 2013

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Transcript of "Pre-term Labour, PPROM, PROM, Prlonged Pregnancy" by Abdallah Badaha

Mo'tasem Ali Basheer

Mosa’b Al-Haj Ahmad 1} Bacterial Vaginosis

2} Progestone

3} Reduction of multiple pregnancy to (2)

4} Cerclage Mode of delivery

Before 26 wks
After 26 wks

* Type of C\S
Ghada Taha

Mohannad Alhadi Idrees Specific:
* Vaginal loss
* Fever
* Palpitation
* Fetal movement C} Investigation

1) CBC
2) C-reactive protein
3) Urine analysis
4) Swap
5) Fetal fibro-nectine
6) U\S A} History

* Symptoms
* Signs
* Previous history Mo’ath M. Idrees Pre-term Labour

Supervisor: Dr. Gamar-Elanbia’ Mohammad

Designed by: Abdallah Badaha

Amro M. Al-Hasan * Fetal Assessment

- U\S
An estimated fetal weight
Continous fetal monitoring Anti-biotics B} Examination

* General ex.
* Abdominal ex.
* Obstetrical ex.
* Pelvic ex.
Abdallah Badaha B} Examination

* General ex.
* Abdominal ex.
* Obstetrical ex.
* Pelvic ex.
Fatima Syed-Ahmad Osman
Fatima Al-zahra’ Hamza Pre-Term Labour
Prolonged Pregnancy Mohammad Abdel-Ghani Classification Definition Prevalence Pre-term Labour Aetiology 6- Idiopathic Other Physiology Pre-term Labour & PPROM
Risk Factors
Factors in current pregnancy Non-Modifiable major Non-Modifiable minor Modifiable How To Diagnose Pre-term Labour ??! C} Investigation

1) CBC
2) MSU
3) Swap
4) U/S Treatment Treatment cont. Inutero Transfer Communication

* With woman & her family
* With neonatal unit staff Analgesia Management of high risk asymptomatic
women Pre-labour Rupture of membrane

Management Investigation Definition

Incidence 8% Treatment

Outpatient expectant Prolonged Pregnancy 3bdallah Bada7a THANK YOU :) How To Diagnose PPROM ??! Maternal Steroid Tocolytic GOALS Traditional methods New developments 1- Infection 2- Over distention 3- Vascular 4- Inter current illness 5- Cervical weakness 1-Reduce or inhibit uterine contraction
2-Delay delivery time
3-Optimize fetal status 1- Chance to reach hospital
2- Chance to use steroids Why we use tocolytics? We select tocolytics according to:

1-Maternal condition
3-Side effects 1-Accelerate fetal lung maturity
2-Decrease risk of RDS
3-Decrease risk of NEC
4-Decrease risk of IVH Steroids of choice:

* Betamethasone 12 mg IM q24 hrs for 2 days
* Dexamethasone 6 mg IM q12 hrs for 2 days * As prophylaxis for ( GBS infection,
neonatal sepsis)
Penicillin or erythromycin 1-bed rest
2-Pelvic rest
4-No coitus

* But they have not proven to be effective * Recent studies suggest possible role for use of progesterone ??! Why we use steroids? Why it used? When we give steroids? * 24-34 wks GA

* Optimal benefits begin after 24 hrs and end
by 7 days •Fetal fibronoctine is a "glue-like protein binding the choriodecidual membranes.

•It's rarely present in vaginal secretion between 22-36 "23-34" weeks. •Any disruption in the choriodecidual interface result in "fFN" release & possible detection in the cervicovaginal secretion such a disruption commonly proceeds preterm labour often by many weeks. •Two tests are available to detect "fFN" in the vaginal secretion:

1)Slow quantitative, laboratory based assay gives precise concentration.
2)Rapid qualitative, bed side test has been design to give a positive-negative result. Post maturity

-Pregnancy exceeding 42 completed weeks or, more from LMP.
-It is associated with increased prenatal mortality 5/1000 if 37-42 w
9.7/1000 if > 42w Diagnosis

•U/S History

* Absolutely the LMP is certain Examination

Assessment of uterine size between 8th and 14th by bimanual pelvic ex by an experienced obstetrician U/S

CRL and BPD Clinical significance

The delayed onset of labor have two disadvantages:

1.Placental insufficiency.
2.Mechanical difficulties. Management * Definition

Rupture of membrane & leakage of fluid
before 37 wks. Can cause: Causes of PPROM: 1. Unknown
2. Infection
3. Multiple pregnancy
4. Polyhydraminus
5. Cervical weakness
6. Uterine anomalies 1. Preterm labour 1/3
2. Infection 1/3
3. lung hypoplasia
4. limb contraction A} History Management

* It depends .. if there is chorioamnionitis or not !!

* If there is >> 1) Broad spectrum antibiotecs
2) Steroid
3) Delivery

* If there is not >> 1) Erythromycin
2) Steroid
3) Admission Prognosis:

1) GA "PPROM or delivery"
2) Cause GA Survival Rate

23 1%
24 11%
25 26%
26 44% Growth & Monitoring are GA dependent !! Signs: Symptoms:

1) Fever 1) Pyrexia
2) Abdominal pain 2) Abdominal tendrness
3) Offensive liqour 3) Offensive vaginal odor
4) palpitation 4) Fetal tachycardia
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