Preterm labor resident survival guide: Difference between revisions
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==Causes== | ==Causes== | ||
[[Intra-amniotic infection]] so far has only been shown to cause preterm delivery.<ref name="pmid11520399">{{cite journal |vauthors=Romero R, Gómez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim YM |title=The role of infection in preterm labour and delivery |journal=Paediatr Perinat Epidemiol |volume=15 Suppl 2 |issue= |pages=41–56 |date=July 2001 |pmid=11520399 |doi=10.1046/j.1365-3016.2001.00007.x |url= |issn=}}</ref> The other factors are being associated based on reports by clinical, [[epidemiologic]], placental [[Pathological|pathologic]], or experimental studies.[[Intra-amniotic infection|Intra-amniotic infections]] can be subclinical. One in four preterm [[infants]] are born due to this [[Causes|cause]].<ref name="pmid25124429">{{cite journal| author=Romero R, Dey SK, Fisher SJ| title=Preterm labor: one syndrome, many causes. | journal=Science | year= 2014 | volume= 345 | issue= 6198 | pages= 760-5 | pmid=25124429 | doi=10.1126/science.1251816 | pmc=4191866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25124429 }} </ref> | [[Intra-amniotic infection]] so far has only been shown to cause [[Preterm labor and birth|preterm]] [[delivery]].<ref name="pmid11520399">{{cite journal |vauthors=Romero R, Gómez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim YM |title=The role of infection in preterm labour and delivery |journal=Paediatr Perinat Epidemiol |volume=15 Suppl 2 |issue= |pages=41–56 |date=July 2001 |pmid=11520399 |doi=10.1046/j.1365-3016.2001.00007.x |url= |issn=}}</ref> The other factors are being associated based on reports by clinical, [[epidemiologic]], placental [[Pathological|pathologic]], or experimental studies.[[Intra-amniotic infection|Intra-amniotic infections]] can be subclinical. One in four preterm [[infants]] are born due to this [[Causes|cause]].<ref name="pmid25124429">{{cite journal| author=Romero R, Dey SK, Fisher SJ| title=Preterm labor: one syndrome, many causes. | journal=Science | year= 2014 | volume= 345 | issue= 6198 | pages= 760-5 | pmid=25124429 | doi=10.1126/science.1251816 | pmc=4191866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25124429 }} </ref> | ||
*[[Infection]]: | *[[Infection]]: | ||
**The most frequent route is the ascending pathway, but hematogenous dissemination can occur. | **The most frequent route is the ascending pathway, but hematogenous dissemination can occur. | ||
**[[Microorganisms]] are recognized by pattern recognition receptors, such as [[toll-like receptors]] (TLRs) | **[[Microorganisms]] are recognized by pattern recognition receptors, such as [[toll-like receptors]] (TLRs) | ||
**[[TLR]]s stimulate the production of [[chemokines]] ([[IL-8]], [[C-C motif ligand 2]] (CCL2), etc.), [[cytokines]] ([[IL-1b]], [[TNF-a]], etc), [[prostaglandins]] and [[proteases]] which activate the quiescent [[myometrium]] and stimulates parturition.<ref name="pmid25124429">{{cite journal| author=Romero R, Dey SK, Fisher SJ| title=Preterm labor: one syndrome, many causes. | journal=Science | year= 2014 | volume= 345 | issue= 6198 | pages= 760-5 | pmid=25124429 | doi=10.1126/science.1251816 | pmc=4191866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25124429 }} </ref> | **[[TLR]]s stimulate the production of [[chemokines]] ([[IL-8]], [[C-C motif ligand 2]] (CCL2), etc.), [[cytokines]] ([[IL-1b]], [[TNF-a]], etc), [[prostaglandins]] and [[proteases]] which activate the quiescent [[myometrium]] and stimulates [[parturition]].<ref name="pmid25124429">{{cite journal| author=Romero R, Dey SK, Fisher SJ| title=Preterm labor: one syndrome, many causes. | journal=Science | year= 2014 | volume= 345 | issue= 6198 | pages= 760-5 | pmid=25124429 | doi=10.1126/science.1251816 | pmc=4191866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25124429 }} </ref> | ||
**In 30% of cases of [[intra-amniotic infection]], [[bacteria]] can be found in the [[fetal circulation]] which causes [[fetal]] [[systemic inflammatory response]]. These fetuses are at risk for long-term [[complications]], such as [[cerebral palsy]] and [[chronic lung disease]], which emphasizes that these [[complications]] may not only occur due to immaturity but also [[inflammatory]] response.<ref name="pmid25124429">{{cite journal| author=Romero R, Dey SK, Fisher SJ| title=Preterm labor: one syndrome, many causes. | journal=Science | year= 2014 | volume= 345 | issue= 6198 | pages= 760-5 | pmid=25124429 | doi=10.1126/science.1251816 | pmc=4191866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25124429 }} </ref> | **In 30% of cases of [[intra-amniotic infection]], [[bacteria]] can be found in the [[fetal circulation]] which causes [[fetal]] [[systemic inflammatory response]]. These fetuses are at risk for long-term [[complications]], such as [[cerebral palsy]] and [[chronic lung disease]], which emphasizes that these [[complications]] may not only occur due to immaturity but also [[inflammatory]] response.<ref name="pmid25124429">{{cite journal| author=Romero R, Dey SK, Fisher SJ| title=Preterm labor: one syndrome, many causes. | journal=Science | year= 2014 | volume= 345 | issue= 6198 | pages= 760-5 | pmid=25124429 | doi=10.1126/science.1251816 | pmc=4191866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25124429 }} </ref> | ||
*[[Uterine ovedistension]] | *[[Uterine ovedistension]] | ||
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*Decline in [[progesterone]] action<ref name="pmid16339279">{{cite journal |vauthors=Condon JC, Hardy DB, Kovaric K, Mendelson CR |title=Up-regulation of the progesterone receptor (PR)-C isoform in laboring myometrium by activation of nuclear factor-kappaB may contribute to the onset of labor through inhibition of PR function |journal=Mol Endocrinol |volume=20 |issue=4 |pages=764–75 |date=April 2006 |pmid=16339279 |doi=10.1210/me.2005-0242 |url= |issn=}}</ref> | *Decline in [[progesterone]] action<ref name="pmid16339279">{{cite journal |vauthors=Condon JC, Hardy DB, Kovaric K, Mendelson CR |title=Up-regulation of the progesterone receptor (PR)-C isoform in laboring myometrium by activation of nuclear factor-kappaB may contribute to the onset of labor through inhibition of PR function |journal=Mol Endocrinol |volume=20 |issue=4 |pages=764–75 |date=April 2006 |pmid=16339279 |doi=10.1210/me.2005-0242 |url= |issn=}}</ref> | ||
*Breakdown in [[maternal]]-[[fetal]] tolerance. | *Breakdown in [[maternal]]-[[fetal]] tolerance. | ||
*Placental abruption, | *[[Placental abruption]], [[Placenta previa]] | ||
*Smoking<ref name="pmid8760711">{{cite journal |vauthors=Wisborg K, Henriksen TB, Hedegaard M, Secher NJ |title=Smoking during pregnancy and preterm birth |journal=Br J Obstet Gynaecol |volume=103 |issue=8 |pages=800–5 |date=August 1996 |pmid=8760711 |doi=10.1111/j.1471-0528.1996.tb09877.x |url= |issn=}}</ref> | *[[Smoking]]<ref name="pmid8760711">{{cite journal |vauthors=Wisborg K, Henriksen TB, Hedegaard M, Secher NJ |title=Smoking during pregnancy and preterm birth |journal=Br J Obstet Gynaecol |volume=103 |issue=8 |pages=800–5 |date=August 1996 |pmid=8760711 |doi=10.1111/j.1471-0528.1996.tb09877.x |url= |issn=}}</ref> | ||
*Maternal age <18 or >40 <ref name="pmid29385154">{{cite journal |vauthors=Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F |title=Effect of maternal age on the risk of preterm birth: A large cohort study |journal=PLoS One |volume=13 |issue=1 |pages=e0191002 |date=2018 |pmid=29385154 |pmc=5791955 |doi=10.1371/journal.pone.0191002 |url= |issn=}}</ref> | *[[Maternal age effect|Maternal age]] <18 or >40 <ref name="pmid29385154">{{cite journal |vauthors=Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F |title=Effect of maternal age on the risk of preterm birth: A large cohort study |journal=PLoS One |volume=13 |issue=1 |pages=e0191002 |date=2018 |pmid=29385154 |pmc=5791955 |doi=10.1371/journal.pone.0191002 |url= |issn=}}</ref> | ||
*Poor nutrition, low body mass index | *Poor [[nutrition]], low [[body mass index]] | ||
*Fetal anomaly<ref name="pmid21962626">{{cite journal |vauthors=Craigo SD |title=Indicated preterm birth for fetal anomalies |journal=Semin Perinatol |volume=35 |issue=5 |pages=270–6 |date=October 2011 |pmid=21962626 |doi=10.1053/j.semperi.2011.05.011 |url= |issn=}}</ref> | *Fetal anomaly<ref name="pmid21962626">{{cite journal |vauthors=Craigo SD |title=Indicated preterm birth for fetal anomalies |journal=Semin Perinatol |volume=35 |issue=5 |pages=270–6 |date=October 2011 |pmid=21962626 |doi=10.1053/j.semperi.2011.05.011 |url= |issn=}}</ref> | ||
*Fetal growth restriction, oligohydramnios, polyhydramnios | *Fetal growth restriction, [[oligohydramnios]], [[polyhydramnios]] | ||
*Vaginal bleeding<ref name="pmid17207901">{{cite journal |vauthors=Hossain R, Harris T, Lohsoonthorn V, Williams MA |title=Risk of preterm delivery in relation to vaginal bleeding in early pregnancy |journal=Eur J Obstet Gynecol Reprod Biol |volume=135 |issue=2 |pages=158–63 |date=December 2007 |pmid=17207901 |pmc=2726845 |doi=10.1016/j.ejogrb.2006.12.003 |url= |issn=}}</ref> | *[[Vaginal bleeding]]<ref name="pmid17207901">{{cite journal |vauthors=Hossain R, Harris T, Lohsoonthorn V, Williams MA |title=Risk of preterm delivery in relation to vaginal bleeding in early pregnancy |journal=Eur J Obstet Gynecol Reprod Biol |volume=135 |issue=2 |pages=158–63 |date=December 2007 |pmid=17207901 |pmc=2726845 |doi=10.1016/j.ejogrb.2006.12.003 |url= |issn=}}</ref> | ||
*Premature preterm rupture of membranes (PPROM)<ref name="pmid9067790">{{cite journal |vauthors=Gomez R, Romero R, Edwin SS, David C |title=Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection |journal=Infect Dis Clin North Am |volume=11 |issue=1 |pages=135–76 |date=March 1997 |pmid=9067790 |doi=10.1016/s0891-5520(05)70347-0 |url= |issn=}}</ref> | *[[Premature rupture of membranes|Premature preterm rupture of membranes]] (PPROM)<ref name="pmid9067790">{{cite journal |vauthors=Gomez R, Romero R, Edwin SS, David C |title=Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection |journal=Infect Dis Clin North Am |volume=11 |issue=1 |pages=135–76 |date=March 1997 |pmid=9067790 |doi=10.1016/s0891-5520(05)70347-0 |url= |issn=}}</ref> | ||
*Environmental factors | *[[Environmental Health Perspectives|Environmental]] factors | ||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 17:22, 1 April 2021
| Preterm labor Resident Survival Guide Microchapters |
|---|
| Overview |
| Causes |
| Diagnosis |
| Treatment |
| Dos |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
Synonyms and keywords:Preterm delivery, Premature labour, Early delivery, Premature birth, Premature labor, Pre term birth
Overview
Causes
Intra-amniotic infection so far has only been shown to cause preterm delivery.[1] The other factors are being associated based on reports by clinical, epidemiologic, placental pathologic, or experimental studies.Intra-amniotic infections can be subclinical. One in four preterm infants are born due to this cause.[2]
- Infection:
- The most frequent route is the ascending pathway, but hematogenous dissemination can occur.
- Microorganisms are recognized by pattern recognition receptors, such as toll-like receptors (TLRs)
- TLRs stimulate the production of chemokines (IL-8, C-C motif ligand 2 (CCL2), etc.), cytokines (IL-1b, TNF-a, etc), prostaglandins and proteases which activate the quiescent myometrium and stimulates parturition.[2]
- In 30% of cases of intra-amniotic infection, bacteria can be found in the fetal circulation which causes fetal systemic inflammatory response. These fetuses are at risk for long-term complications, such as cerebral palsy and chronic lung disease, which emphasizes that these complications may not only occur due to immaturity but also inflammatory response.[2]
- Uterine ovedistension
- Decidual senescence
- Vascular disorders
- Stress
- Cervical disease
- Decline in progesterone action[3]
- Breakdown in maternal-fetal tolerance.
- Placental abruption, Placenta previa
- Smoking[4]
- Maternal age <18 or >40 [5]
- Poor nutrition, low body mass index
- Fetal anomaly[6]
- Fetal growth restriction, oligohydramnios, polyhydramnios
- Vaginal bleeding[7]
- Premature preterm rupture of membranes (PPROM)[8]
- Environmental factors
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Dos
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Romero R, Gómez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim YM (July 2001). "The role of infection in preterm labour and delivery". Paediatr Perinat Epidemiol. 15 Suppl 2: 41–56. doi:10.1046/j.1365-3016.2001.00007.x. PMID 11520399.
- ↑ 2.0 2.1 2.2 Romero R, Dey SK, Fisher SJ (2014). "Preterm labor: one syndrome, many causes". Science. 345 (6198): 760–5. doi:10.1126/science.1251816. PMC 4191866. PMID 25124429.
- ↑ Condon JC, Hardy DB, Kovaric K, Mendelson CR (April 2006). "Up-regulation of the progesterone receptor (PR)-C isoform in laboring myometrium by activation of nuclear factor-kappaB may contribute to the onset of labor through inhibition of PR function". Mol Endocrinol. 20 (4): 764–75. doi:10.1210/me.2005-0242. PMID 16339279.
- ↑ Wisborg K, Henriksen TB, Hedegaard M, Secher NJ (August 1996). "Smoking during pregnancy and preterm birth". Br J Obstet Gynaecol. 103 (8): 800–5. doi:10.1111/j.1471-0528.1996.tb09877.x. PMID 8760711.
- ↑ Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F (2018). "Effect of maternal age on the risk of preterm birth: A large cohort study". PLoS One. 13 (1): e0191002. doi:10.1371/journal.pone.0191002. PMC 5791955. PMID 29385154.
- ↑ Craigo SD (October 2011). "Indicated preterm birth for fetal anomalies". Semin Perinatol. 35 (5): 270–6. doi:10.1053/j.semperi.2011.05.011. PMID 21962626.
- ↑ Hossain R, Harris T, Lohsoonthorn V, Williams MA (December 2007). "Risk of preterm delivery in relation to vaginal bleeding in early pregnancy". Eur J Obstet Gynecol Reprod Biol. 135 (2): 158–63. doi:10.1016/j.ejogrb.2006.12.003. PMC 2726845. PMID 17207901.
- ↑ Gomez R, Romero R, Edwin SS, David C (March 1997). "Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection". Infect Dis Clin North Am. 11 (1): 135–76. doi:10.1016/s0891-5520(05)70347-0. PMID 9067790.