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Definition
Start of labor before 37 weeks of
gestation.
Incidence:
Preterm =10%
Term =80%
Post term=10%
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Causes: Maternal
Maternal:
1. Pregnancy complication:-PET, APH, PROM, Polyhyd
ramnios
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Causes: Fetal/placental
Fetal: Others:
1. Multiple pregnancy 1. Idiopathic
2. IUFD 2. Premature induction
3. Malformed fetus 3. Past abortion/ preterm
Placental: del.
1. Abruption/Previa 4. Smoking
2. Thrombosis/Infarction
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Diagnosis
All symptoms and signs Signs:
of labor Contraction
Symptoms: Dilatation>2cm
28-36 weeks of Effacement
gestation PROM
Show
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Principle of Management
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Management:1
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Management:2
1. Bed rest
2. Hydration
3. B2-Agonist:
1. Salbutamol=2-4mg x 3 P/O
2. Terbutalin=0.25mg q3-4hrs S/C
3. Ritodrine=50micg/min+@50micg/min q10min
4. Isoxsuprine=10mg x 3 P/O; 40mg infusion@12-15drops/mi
n
4. Ca++channel blockers:
1. Nifedipine= 5-10mg q6-8hrs S/L
5. PGInhibitors:
1. Indomethacin=50mg25mg q6hrs x 48hrs P/O
6. MgSO4=5gm infusion in 30min1-2gm/hr
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Management:3
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Contraindication to Tocolysis
IUFD Uncontrolled medical
Fetal distress disease:
DM
Chorioamnionitis
HTN
Placenta previa/abruption Cardiac disease
Abnormal baby Thyroid disorder
Active labor Unstable maternal
Rupture of membrane condition
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Vaginal Delivery
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Operative delivery
1. Vacuum- Contraindicated
2. Forceps-
All cephalic presentation
After coming head of breech
3. CS-
Breech:
1. Head>Trunk
2. Risk of cord prolapse
3. Head entrapment by incompletely dilated cx
Multiple pregnancy
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Complication
High morbidity
High mortality
Adverse effect of medication
Maternal DM deteriorated by glucocorticoids
Occult chorioamnionitis flared up by:
Glucocorticoids
Tocolytics
Costly neonatal treatment
Neonatal intensive care
Surfactant
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