8 - Obs - Preterm Delivery - Background, Complx + Aetiology Flashcards
Delivery ?-?wks. Most important pre-?wks – neonatal risks ?. Before ?wks, labour is tantamount to a ?, though v few do survive at ?wks. ?-?% deliveries are preterm.
Preterm deliv can be result of: ? labour, or usually at ?
gestations can be ? (delivery expedited by obstetrician due to ?).
24-37 34 higher 24 miscarriage 23 5-8 spont later iatrogenic risk
Risks of preterm ? w gestation so threshold for ?
lowers. Most commonly ? – delivery is only ?, preg affected at ?wks would have high risk if continued to ?.
lessen induction preeclampsia cure 28 term
Complications
Neonatal: Prematurity -> 80% of ???? occupancy, 20% ? mort and 50% ? ? . Other long term morb inc chronic ?
disease, ? and minor disability common. Earlier gestation = ? risk to fetus. 24wks: 1/3rd babies ? , 1/3rd ?. 32wks: both risks %.
Maternal: ? freq ass w preterm labour and can -> severe maternal illness and ?, ?
is common. ? ? more commonly used.
NICU perinatal cerebral palsy lung blindness increased die handicapped <5 infection postnatally endometritis C/S
RF’s
Many, prev ?, lower ? ?, extremes of mat ?, ? inter-preg interval, maternal disease eg ?
failure, ?? and thyroid disease, preg compx inc ? or ????, ? fetal gender, high ?, ???s and vaginal ? eg BV, prev ? surgery, ? preg, uterine abnormality/?, UTI, ?, ? fetal abnormality and ???.
Hx social class age shorter renal DM preeclampsia IUGR male Hb STI infection cervical multiple fibroids polyhydramnios congen APH
Mechanisms
? = castle, ? = wall holding defenders in.
Too many defenders: ? preg, 20% ? deliver pre34wks, ?wks is mean deliv time for ?. ?
has same effect, prob mediated by incr ?.
Defenders jump out: Fetal ?
response, ? preterm labour more common when fetus at ? eg pre-eclampsia and IUGR, or if ?. Also placental ? often followed by ?. ? preterm deliv can improve upon this.
uterus
cervix
multi twins 34 triplets polyhydramnios stretch
survival spont risk infection abruption labour iatrogenic
Mechanisms
Castle design poor: Uterine abnormalities eg ? or congen abnormalities.
Wall is weak: ? incompetence = painless ? preceding some preterm deliveries.
Some follow ? for CIN or ?, or multiple ? of the cervix. Or no RFs.
Enemy get around walls: ???
and poor ? health are RFs.
fibroids
cervical dilatation surgery cancer dilatations
UTI
dental
Mechanisms
Enemy knock down walls: ?
implicated in 60% preterm deliveries, often ?. Chorioamnionitis, ? liquor, neonatal ? and endometritis after ? = all manifestations. ?? = RF, ???, trichomonas, ? and commensals also indicated. Effects dependent on ? and infection.
infection subclinical offensive sepsis delivery BV GBS chlamydia cervix
