is delivery before 37 completed weeks. it is the reason for 2/3 of fetal death in first year of live .The over all infant mortality has continued to decline but the mortality associated with preterm birth is not.

Preterm birth

.

Long term out comes.The high rate of significant neonatal morbidity in these immature neonates and diminished likelihood of normal life must be weighed against the apparent triumph of survival studies showed that follow up of neonate born at 24 -26 wks.

Report that only 20% totally free of impairment at 5 y They are usually has disabilities in mental and psychomotor development neuromotor function' sensory and communication function .

Economic impact.

They found that more than a1/3 of money expended for infant health care during the first year of life is spent on the 7% of neonates born who weigh less than 2500gm .additional expenditures for developmental handicaps during the remainder of childhood should also be considered .

Causes of preterm birth.

Medical and obstetrical complications.PET . Fetal distress .IUGR .

APH

LIFE STYLE FACTORS.

Smoking ,drug useExtreme of agePovertyVit c deficiencyHeavy workLong working hours.

Recurrent familial and racial nature of preterm birth has lead to suggestion that genetics may play a causal role

Gene for decidual relaxin . Fetal mitochondrial trifunctional protein defects Polymorphism in the interleukin-1 gene complex B2 adrenergic receptor defct

GENETIC FACTORS

Chorio amnionitis.

The pathway of bacteria to enter the (A.F) with intact memb. Is unclear.

E.coli can permeate living memb. Bacterial endotoxin stimulate decidual monocytes to produce cytokines which stimulate arachidonic acid and prostaglandins E2&F2 alph

Bacterial vaginosis.

Lacto bacillus ( release hydrogee peroxide)

Replaced with anaerobes

Periodontal disease

Oral bacteria especially

FusobacteriumIncrease the preterm

labor by 7 fold.

Fetal fibronection

• Glycoprotein. • Release by fetal amnion. • Present in high conc. in maternal blood &A.F• It is thought to playaroule in placenta adhesion to the

decidua• Present of fibonectin In cervico vaginal secretion prior to

memb• Rupture is possible marker for impending preterm labor.• (the predictive value for the delivery . Within 1wk in 30%)

Management preterm rupture of memb .&preterm labor.

• Admission to L /R • Diagnosis of rupture membrane

• Sterile speculum ex • Nitruzine test (pH of A.F 7-7.5 ) • False positive ( blood ,semen ,bacteral vaginosis )• Ferning test (Na .chloride) • If the pt .less than34 wks • Start Antibiotic , fetal heart monitoring • Beta methasone 12mg im 24 hr apart OR

dexamethasone 5mg /12hr (4doses )•

Management of preterm labor with intact membrane

• Admission to L/R

• Corticosteroid therapy thyrotropin releasing hormone (enhances surfactant synthesis)

• anti microbial(clindamycin)• Bed rest hydration & sedation

TOCOLYTIC

B-adrenergic receptor agonists. RitodrineDelay delivery for 48hrS.E ( pulmonary edema ,hyperglycemia ,hypokalemia ,arrhythmia, myocardial ischemia)

Magnesium sulfateS.E ( respiratory depression ,diplopia , muscular paralysis ,cardiac arrest ,)

.• (indomethacin ) • Inhibit P.G synthesis or blocking P.G action on

target organs. • S /E ( oligohydramnios ,renal failure) • (Calcium channel blocker) • (NIFEDIPINE) • S/E (hypotension ,decrease placenta

perfusion ,fetal hypercapnia ,acidosis ,hypoxia in)

• (anti-oxytocin)

TOCOLYTIC