Preterm Delivery

Merry
Cristiani
Olivia

Reference
1. Prawirohardjo S. Ilmu Kebidanan. Jakarta : PT

Bina Pustaka Sarwono Prawirohardjo, 2009

2. Saifuddin AB. Buku Acuan Nasional
Pelayanan Kesehatan Materna dan
Neonatal . Jakarta : PT Bina Pustaka Sarwono
Prawirohardjo, 2009
3. Cunningham,
Leveno,Bloom,Hauth,House,Spong. Preterm
birth in William obstetrics. Ed 23th. USA :
McGraw-Hill, 2010.

Introduction
Labor and delivery between 28 36+6 weeks
5%-10%
be the leading cause of perinatal morbidity and mortality
Survival rates have increased and morbidity has decreased

because of technologic advances

Definition (WHO)

Risk factors for preterm

birth

Non-modifiable

Prior preterm birth

African-American race
Age <18 or >40 years
Poor nutrition/low prepregnancy weight

Modifiable

Cigarette smoking
Substance abuse
Absent prenatal care

Low socioeconomic status

Short interpregnancy intervals

Cervical injury or anomaly

Anemia

Uterine anomaly or fibroid

Premature cervical dilatation (>2 cm) or
effacement (>80 percent)
Over distended uterus (multiple pregnancy,
polyhydramnios)

Bacteriuria/urinary tract infection

Genital infection

Risk factors for preterm

birth
Stress
Single women
Low socioeconomic status
Anxiety
Depression
Life events (divorce, separation,
death)
Abdominal surgery during pregnancy
Occupational fatigue
Upright posture
Use of industrial machines
Physical exertion
Mental or environmental stress
Excessive or impaired uterine
distention
Multiple gestation
Polyhydramnios
Uterine anomaly or fibroids
Diethystilbesterol

Cervical factors
History of second trimester
abortion
History of cervical surgery
Premature cervical dilatation or
effacement
Infection
Sexually transmitted infections
Pyelonephritis
Systemic infection
Bacteriuria
Periodontal disease
Placental pathology
Placenta previa
Abruption
Vaginal bleeding

Pathophysiology

The preterm parturition syndrome. Multiple

pathologic processes can lead to activation of the
common pathway of parturition.

Ascending intrauterine
infections stage I changing
flora vagina/cervix, II
Microorganism alocated
between the amnion and

Infection

Sign and symptom

Diagnosis
Documented uterine contractions(4 per 20 minutes or 8

per 60 minutes)
Documented cervical change (cervical effacement of 80%
or cervical dilatation of 2cm or more)
Premature rupture of membrane
Spotting

PRETERM LABOR
Most mortality and
morbidity is
experienced by
babies born before
34 weeks

Major Risks of Preterm

Delivery

General management
Evacuation condition of mother
Confirm about gestational age for prognostic
Bedrest, hydration, sedation
Evaluation about baby with ultrasound

examination
Plasenta situation
principly : stop contraction of the uterine

When we must delayed the

labor?
1. Gestational age about < 35 weeks
2. Dilatation of cervix < 3 cm
3. Condition when the patient not have

infection, high blood pressure.

4. Theres no fetal distress
purpose: for maturity of membrane and organ
in baby
Management : bed rest, tocolytic therapy
and corticosteroid

Tocolytic therapy
Beta adrenergic receptor agonists

(terbutaline)
Mechanism

Interferes w/ myosin light chain kinase

Inhibits actin myosin interaction

Efficacy
48 hours. No change in perinatal outcome
Side Effects
Tachycardia, palpitations,hypotension,SOB,
pulmonary edema, hyperglycemia
Contraindications
Maternal cardiac disease, uncontrolled diabetes
and hyperthyroidism

Magnesium sulfate
Mechanism of Action
Competes with Calcium at plasma memb

Efficacy
Unproven

Side Effects
Diaphoresis, flushing, pulmonary edema

Contraindications
Myasthesthenia gravis, renal failure

Calcium channel blocker (nipedifin)

Mechanism of Action
Directly block influx of Ca thru cell membrane

Efficacy
Unproven

Side Effects
Nausea, flushing, HA, palpitations

Contraindications
Caution: LV dysfunction, CHF

Corticosteroid Therapy
Dexamethasone and betamethasone
for fetal maturation reduces mortality,

respiratory distress syndrome and

intraventricular hemorrhage in infants
between 28 and 34 weeks of gestation.
benefits start at 24 hours and last up to
seven days after treatment
The potential benefits or risks of repeated
administration of corticosteroids after seven
days are unknown.

Labor and deliverey

With modern neonatal care, the lower limit of potential

viability is 24 weeks or 500g, although these limits vary

with the expertise of the neonatal intensive care unit.
Continuous fetal heart monitoring and prompt attention to
abnormal fetal heart rate patterna are extremely important.
With a vertex presentation, vaginal delivery is preferred.
Use of outlet forceps and an episiotomy to shorten the
second stage are advocated.
Cesarean section for delivery of the very low birth weight
baby
For the breech fetus estimated at less than 1500g, neonatal
outcome is improved by cesarean section

Prevention