1.

Pathophysiology

Precipitating Factors:
1. Stress
a. Single woman
b. Low socioeconomic status
c. Anxiety
d. Depression
2. Occupational fatigue
a. Upright posture
b. Use of industrial machine
c. Physical exertion
d. Mental or environmental stress Predisposing Factors:
3. Infection 1. Previous preterm delivery
a. Sexually transmitted infections 2. Substance abuse
b. Pyelonephritis 3. Smoking
c. Appendicitis, pneumonia Pregnant women 4. Maternal age (< 18 or > 40)
d. Systemic infection 5. African-American race
4. Excessive or impaired uterine distention 6. Poor nutrition and low body mass index
a. Multiple gestation 7. Inadequate prenatal care
b. Polyhidramnion
c. Uterine anomaly
d. Premature rupture of membrane
5. Placental pathology
a. Placenta previa
b. Abruption
6. Cervical factors
a. History of second trimester abortion
b. History of cervical surgery
c. Premature cervical dilatation or effacement
7. Fetal factors
a. Congenital anomaly
b. Growth restriction
 Anxiety Decidua-chorioamnionitis Placenta bleeding Anxiety

Inflammation
mediator released Activated of Xa Increased of Stimulate IL-8,
Insufficiency Stress in mother (pro-inflammatory: prostaglandin,
uteroplasenta and fetus clotting factor hemosistein
IL-1, IL-6, IL-8, and (prothrombinase) and COX-2
TNF-)

Alter thrombin
Cytokines stimulate and prothrombin
1. Increased release of the hormone
the release of CRH
CRH.
2. Alter in ACTH, prostaglandin,
oxytocin receptor, matrix Stimulate HPA of
metalloproteinase (MMP), fetus
interleukin-8, cyclooxygenase-2,
dehydroepiandrosteron sulfate
(DHEAS), and estrogen placenta. Produce cortisol and
3. Enlargement of the adrenal gland DHEAS

Synthesis of uterotonin
(prostaglandin and endotolin)

MEMBRANE UTERUS CERVIX

 Rupture Contractions Opening

Premature delivery

Decrease
Premature infant endurance

Risk of
infection
Body surface tends Subcutaneous fat Organ is not
to be wider tissue is thinner functioning properly

Excessive Exposure to the Heat loss Lack of energy Lung Kidney

evaporation outer temperature of through skin reserves
the uterus
1. Chest wall immature Kidney immature
Fluid Ineffective Malnutrition 2. Lung vascular
deprivation Heat loss thermoregulation immature
Hypoglicemia
Dehydration
Breathing
insufficient
Risk for deficient
fluid volume
Ineffective
breathing pattern
 Eyes
Brain
1. Immaturity of the
Nerve immature eyepiece
2. Secondary effect of O2

Retrolentral fibroplasia
Breathing Weak suckling Swallowing
regulation reflex reflex not good
Retinopathy of
Prematurity
Periodic respiration Ineffective
Biot respiration breastfeeding Imbalance Interrupted
nutrition: less breastfeeding
than body
requirement

Figure 3. Pathophysiology of preterm infant