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APGO educational topic 24 preterm labor
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preterm birth is defined as delivery
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between twenty and thirty seven weeks
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estimated gestational age in the US and
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accounted for 35% of all mortality in
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the first year of life and 70% of all
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neonatal mortality defined as death in
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the first 28 days of life respiratory
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distress infection and intraventricular
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hemorrhage are the leading causes of
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morbidity and mortality for preterm
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infants the preterm birth rate was ten
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point six percent nineteen ninety and
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increased 20% to twelve point eight
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percent of 2006 the rate has slightly
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decreased in recent years and was eleven
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point four percent in 2013 this graph
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shows the marked racial and ethnic
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variations in preterm birth rates United
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States non-hispanic black women and
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American Indian women have the highest
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preterm birth rates at sixteen point
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three and thirteen percent respectively
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the preterm birth rates in the United
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States are approximately double the
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rates in European countries the
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objectives of this video are to identify
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risk factors signs and symptoms of
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preterm labor describe the initial
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management for preterm labor including
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medication indications and
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contraindications list the adverse
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outcomes associated with preterm birth
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and lastly describe counseling to reduce
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the risk of preterm birth in the future
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let’s begin by discussing risk factors
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for preterm birth one of the strongest
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clinical risk factors is a history of a
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preterm birth this confers a one point
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five to two fold increased risk and
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subsequent pregnancies a short cervical
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length defined as less than 25
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millimeters before 24 weeks gestation
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has also been associated with an
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increased risk of preterm birth a
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history of cervical surgery including
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quantization and loop electrode excision
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procedures have been thought to be risk
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factors although multiple confounders
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such as smoking complicate this
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relationship vaginal bleeding urinary
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tract infections genital tract
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infections and periodontal diseases have
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also been associated with an increased
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risk of preterm birth behavioral risk
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factors such as smoking substance abuse
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and low maternal BMI less than nineteen
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point eight and short enterprising C
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intervals are the final risk factors
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preterm labor is characterized by
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uterine contractions
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cervical dilation and/or effacement the
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management for preterm labor differs by
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gestational age between 24 and 34 weeks
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the most important intervention is
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administration of corticosteroids this
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reduces rates of respiratory distress
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syndrome intracranial hemorrhage
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necrotizing enterocolitis and death
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tocolytics era P is used only for
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short-term prolongation of pregnancy for
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enabling the administration of
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corticosteroids as well as transport if
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needed to a tertiary care facility
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magnesium sulfate is now widely used if
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delivery is believed to be imminent
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before 32 weeks for evidence suggest
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that this reduces the severity and risk
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of cerebral palsy and surviving infants
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there are four classes of commonly used
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to Kalitta cajon’s calcium channel
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blockers such as my fetid Pienaar the
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first class and these cannot be used if
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there is maternal hypotension or preload
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dependant cardiac lesions such as a or
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degree sufficiency non-steroidal
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anti-inflammatory drugs cannot be used
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if there is platelet dysfunction or
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bleeding disorders hepatic dysfunction
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gi ulcerative disease renal dysfunction
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and asthma for women who are
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hypersensitive to aspirin beta
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adrenergic receptor agonist such as
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terbutaline cannot be used with
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tachycardia sensitive cardiac disease
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and poorly controlled diabetes mellitus
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magnesium sulfate is the fourth class
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vitoca lytic and this medication cannot
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be used if the patient has myasthenia
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gravis remember that these tocolytics
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are only used for short-term
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prolongation of pregnancy there is no
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benefit of tocolytics era P for longer
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term prolongation of pregnancy for many
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years we did not have any interventions
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that could prevent preterm birth however
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we now know that progesterone therapy
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can reduce the risk progesterone causes
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inhibition of cervical ripening
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reduction of myometrium contractility
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and is a modulator of inflammation women
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who have had a history of a preterm
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birth or who have a short cervix should
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receive progesterone therapy we can now
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counsel women who have had a preterm
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birth that progesterone therapy is an
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intervention that we can offer to try to
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decrease the risk of future preterm
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delivery this concludes the aapko video
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on preterm labor we have discussed the
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adverse outcomes risk factors signs
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symptoms management and strategies for
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reducing preterm birth
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you