Preterm labor resident survival guide: Difference between revisions

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**[[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]] over distension
*[[Decidual senescence]]
*[[Decidual cells|Decidual]] senescence
*[[Vascular disorders]]
*[[Vascular disorders]]
*[[Stress]]
*[[Stress]]
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*[[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>
*[[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]]
*[[Fetus|Fetal]] [[growth]] [[Growth failure|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 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>
*[[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>

Revision as of 07:18, 2 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]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Preterm labor:

Abbreviations: BP: Blood pressure; RR=Respiratory rate; HR=Heart Rate, PROM= Premature rupture of membranes; AFV= Amniotic fluid volume

 
 
 
 
 
 
Pregnant woman comes with Preterm labor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take obstetric history :

❑ Date of last menstrual period?

❑ Estimated date of delivery.

❑ Confirm the gestational age, gravidity and parity.

❑ Check if this is a single or multiple gestation.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about previous obstetric history if she was previously pregnant :

❑ Ask about previous pregnancies including miscarriages and terminations.

❑ Length of gestation.

❑ Ask about mode of delivery.

❑ Ask if there was similar complaints during previous pregnancy?

❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history :

❑ Age of menarche

❑ Last menstrual period

❑ Is the menstrual flow normal? How many pads she has to use in a day?

❑ Is there any foul smell or colour change?

❑ How many days does the menstruation stay?

Contraceptive history for example oral contraceptives, intrauterine device

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform physical examination :











 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 








 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 








 
 
 
 
 
 
 
 
 
 
 
 
 
 

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

  1. 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. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.


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