{"id":218,"date":"2020-08-13T16:27:19","date_gmt":"2020-08-13T16:27:19","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=218"},"modified":"2023-09-30T10:33:53","modified_gmt":"2023-09-30T10:33:53","slug":"24-preterm-labor","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/24-preterm-labor\/","title":{"rendered":"24. Preterm Labor"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/uhxegeNNQp4\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 4:29<\/p>\n<input type='hidden' bg_collapse_expand='69e9dbea221c63035519804' value='69e9dbea221c63035519804'><input type='hidden' id='bg-show-more-text-69e9dbea221c63035519804' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dbea221c63035519804' value='Hide Transcript'><button id='bg-showmore-action-69e9dbea221c63035519804' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dbea221c63035519804' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic 24 preterm labor<br \/>\n00:04<br \/>\npreterm birth is defined as delivery<br \/>\n00:06<br \/>\nbetween twenty and thirty seven weeks<br \/>\n00:08<br \/>\nestimated gestational age in the US and<br \/>\n00:11<br \/>\naccounted for 35% of all mortality in<br \/>\n00:13<br \/>\nthe first year of life and 70% of all<br \/>\n00:16<br \/>\nneonatal mortality defined as death in<br \/>\n00:19<br \/>\nthe first 28 days of life respiratory<br \/>\n00:22<br \/>\ndistress infection and intraventricular<br \/>\n00:24<br \/>\nhemorrhage are the leading causes of<br \/>\n00:26<br \/>\nmorbidity and mortality for preterm<br \/>\n00:27<br \/>\ninfants the preterm birth rate was ten<br \/>\n00:30<br \/>\npoint six percent nineteen ninety and<br \/>\n00:31<br \/>\nincreased 20% to twelve point eight<br \/>\n00:33<br \/>\npercent of 2006 the rate has slightly<br \/>\n00:36<br \/>\ndecreased in recent years and was eleven<br \/>\n00:38<br \/>\npoint four percent in 2013 this graph<br \/>\n00:41<br \/>\nshows the marked racial and ethnic<br \/>\n00:43<br \/>\nvariations in preterm birth rates United<br \/>\n00:44<br \/>\nStates non-hispanic black women and<br \/>\n00:47<br \/>\nAmerican Indian women have the highest<br \/>\n00:48<br \/>\npreterm birth rates at sixteen point<br \/>\n00:50<br \/>\nthree and thirteen percent respectively<br \/>\n00:52<br \/>\nthe preterm birth rates in the United<br \/>\n00:55<br \/>\nStates are approximately double the<br \/>\n00:56<br \/>\nrates in European countries the<br \/>\n00:58<br \/>\nobjectives of this video are to identify<br \/>\n01:00<br \/>\nrisk factors signs and symptoms of<br \/>\n01:02<br \/>\npreterm labor describe the initial<br \/>\n01:04<br \/>\nmanagement for preterm labor including<br \/>\n01:06<br \/>\nmedication indications and<br \/>\n01:08<br \/>\ncontraindications list the adverse<br \/>\n01:10<br \/>\noutcomes associated with preterm birth<br \/>\n01:12<br \/>\nand lastly describe counseling to reduce<br \/>\n01:16<br \/>\nthe risk of preterm birth in the future<br \/>\n01:18<br \/>\nlet&#8217;s begin by discussing risk factors<br \/>\n01:21<br \/>\nfor preterm birth one of the strongest<br \/>\n01:23<br \/>\nclinical risk factors is a history of a<br \/>\n01:25<br \/>\npreterm birth this confers a one point<br \/>\n01:27<br \/>\nfive to two fold increased risk and<br \/>\n01:29<br \/>\nsubsequent pregnancies a short cervical<br \/>\n01:32<br \/>\nlength defined as less than 25<br \/>\n01:33<br \/>\nmillimeters before 24 weeks gestation<br \/>\n01:35<br \/>\nhas also been associated with an<br \/>\n01:37<br \/>\nincreased risk of preterm birth a<br \/>\n01:39<br \/>\nhistory of cervical surgery including<br \/>\n01:41<br \/>\nquantization and loop electrode excision<br \/>\n01:43<br \/>\nprocedures have been thought to be risk<br \/>\n01:45<br \/>\nfactors although multiple confounders<br \/>\n01:47<br \/>\nsuch as smoking complicate this<br \/>\n01:48<br \/>\nrelationship vaginal bleeding urinary<br \/>\n01:51<br \/>\ntract infections genital tract<br \/>\n01:53<br \/>\ninfections and periodontal diseases have<br \/>\n01:55<br \/>\nalso been associated with an increased<br \/>\n01:57<br \/>\nrisk of preterm birth behavioral risk<br \/>\n01:59<br \/>\nfactors such as smoking substance abuse<br \/>\n02:02<br \/>\nand low maternal BMI less than nineteen<br \/>\n02:04<br \/>\npoint eight and short enterprising C<br \/>\n02:06<br \/>\nintervals are the final risk factors<br \/>\n02:08<br \/>\npreterm labor is characterized by<br \/>\n02:10<br \/>\nuterine contractions<br \/>\n02:12<br \/>\ncervical dilation and\/or effacement the<br \/>\n02:14<br \/>\nmanagement for preterm labor differs by<br \/>\n02:16<br \/>\ngestational age between 24 and 34 weeks<br \/>\n02:19<br \/>\nthe most important intervention is<br \/>\n02:21<br \/>\nadministration of corticosteroids this<br \/>\n02:23<br \/>\nreduces rates of respiratory distress<br \/>\n02:25<br \/>\nsyndrome intracranial hemorrhage<br \/>\n02:26<br \/>\nnecrotizing enterocolitis and death<br \/>\n02:28<br \/>\ntocolytics era P is used only for<br \/>\n02:30<br \/>\nshort-term prolongation of pregnancy for<br \/>\n02:33<br \/>\nenabling the administration of<br \/>\n02:34<br \/>\ncorticosteroids as well as transport if<br \/>\n02:36<br \/>\nneeded to a tertiary care facility<br \/>\n02:38<br \/>\nmagnesium sulfate is now widely used if<br \/>\n02:41<br \/>\ndelivery is believed to be imminent<br \/>\n02:42<br \/>\nbefore 32 weeks for evidence suggest<br \/>\n02:44<br \/>\nthat this reduces the severity and risk<br \/>\n02:46<br \/>\nof cerebral palsy and surviving infants<br \/>\n02:48<br \/>\nthere are four classes of commonly used<br \/>\n02:50<br \/>\nto Kalitta cajon&#8217;s calcium channel<br \/>\n02:52<br \/>\nblockers such as my fetid Pienaar the<br \/>\n02:53<br \/>\nfirst class and these cannot be used if<br \/>\n02:56<br \/>\nthere is maternal hypotension or preload<br \/>\n02:58<br \/>\ndependant cardiac lesions such as a or<br \/>\n02:59<br \/>\ndegree sufficiency non-steroidal<br \/>\n03:02<br \/>\nanti-inflammatory drugs cannot be used<br \/>\n03:04<br \/>\nif there is platelet dysfunction or<br \/>\n03:05<br \/>\nbleeding disorders hepatic dysfunction<br \/>\n03:07<br \/>\ngi ulcerative disease renal dysfunction<br \/>\n03:09<br \/>\nand asthma for women who are<br \/>\n03:11<br \/>\nhypersensitive to aspirin beta<br \/>\n03:13<br \/>\nadrenergic receptor agonist such as<br \/>\n03:15<br \/>\nterbutaline cannot be used with<br \/>\n03:16<br \/>\ntachycardia sensitive cardiac disease<br \/>\n03:18<br \/>\nand poorly controlled diabetes mellitus<br \/>\n03:20<br \/>\nmagnesium sulfate is the fourth class<br \/>\n03:22<br \/>\nvitoca lytic and this medication cannot<br \/>\n03:24<br \/>\nbe used if the patient has myasthenia<br \/>\n03:26<br \/>\ngravis remember that these tocolytics<br \/>\n03:28<br \/>\nare only used for short-term<br \/>\n03:30<br \/>\nprolongation of pregnancy there is no<br \/>\n03:32<br \/>\nbenefit of tocolytics era P for longer<br \/>\n03:35<br \/>\nterm prolongation of pregnancy for many<br \/>\n03:37<br \/>\nyears we did not have any interventions<br \/>\n03:39<br \/>\nthat could prevent preterm birth however<br \/>\n03:41<br \/>\nwe now know that progesterone therapy<br \/>\n03:43<br \/>\ncan reduce the risk progesterone causes<br \/>\n03:46<br \/>\ninhibition of cervical ripening<br \/>\n03:48<br \/>\nreduction of myometrium contractility<br \/>\n03:50<br \/>\nand is a modulator of inflammation women<br \/>\n03:54<br \/>\nwho have had a history of a preterm<br \/>\n03:56<br \/>\nbirth or who have a short cervix should<br \/>\n03:58<br \/>\nreceive progesterone therapy we can now<br \/>\n04:01<br \/>\ncounsel women who have had a preterm<br \/>\n04:02<br \/>\nbirth that progesterone therapy is an<br \/>\n04:04<br \/>\nintervention that we can offer to try to<br \/>\n04:06<br \/>\ndecrease the risk of future preterm<br \/>\n04:08<br \/>\ndelivery this concludes the aapko video<br \/>\n04:10<br \/>\non preterm labor we have discussed the<br \/>\n04:12<br \/>\nadverse outcomes risk factors signs<br \/>\n04:13<br \/>\nsymptoms management and strategies for<br \/>\n04:15<br \/>\nreducing preterm birth<br \/>\n04:21<br \/>\nyou<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 4:29<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":24,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-218","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/218","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=218"}],"version-history":[{"count":4,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/218\/revisions"}],"predecessor-version":[{"id":1281,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/218\/revisions\/1281"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=218"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}