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1
Q

Classification of fetuses & neonates according to GA

A
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2
Q

Classification of fetuses & neonates according to GA

  • Preterm
A
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3
Q

Classification of fetuses & neonates according to GA

  • Term
A

GA from 37 week up to 42 weeks

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4
Q

Classification of fetuses & neonates according to GA

  • Post-term
A

GA > completed 42 weeks.

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5
Q

Classification of fetuses according to fetal weight in relation to GA

A
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6
Q

Classification of fetuses according to fetal weight in relation to GA

  • SGA
A
  • Fetal weight < 10th percentile for GA
  • Fetal weight ≥ 2 SD below mean for its GA

(SGA fetuses include IUGR or constitutionally small but healthy fetus)

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7
Q

Classification of fetuses according to fetal weight in relation to GA

  • AGA
A

Fetal weight ( ) 10th & 90th percentile for GA

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8
Q

Classification of fetuses according to fetal weight in relation to GA

  • LGA
A
  • Fetal weight > 90th percentile for GA
  • Fetal weight ≥ 2 SD above mean for its GA.
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9
Q

Classification of neonates according to birth weight

A
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10
Q

Classification of neonates according to birth weight

  • NBW
A

Neonates with birth weight > 2500 gm.

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11
Q

Classification of neonates according to birth weight

  • LBW
A
  • Neonates with birth weight ≤ 2500 gm regardless GA (LBW infants include preterm & growth retarded infants).
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12
Q

Classification of neonates according to birth weight

  • VLBW
A
  • Neonates with birth weight < 1500 gm regardless GA
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13
Q

Def of Preterm labor (premature labor)

A

Onset of labor after fetal viability & before completed

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14
Q

Def of Prematurity

A
  • Baby needs artificial aids to maintain life (needs incubation) due to deficiency of different body functions to face extrauterine life.
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15
Q

Incidence of Prematurity

A

7% of all deliveries.

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16
Q

Etiology & RF for Prematurity

A
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17
Q

Etiology & RF for Prematurity

  • Maternal Factors
A
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18
Q

Etiology & RF for Prematurity

  • fetal Factors
A

1) Fetal anomalies
2) multiple infections as TORCH
3) IUFD.

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19
Q

Etiology & RF for Prematurity

  • obstetric Compications
A

1) Polyhydramnios, PPROM
2) Chorioamnionitis
3) placenta previa, placental abruption
4) pregnancy on top of IUD.

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20
Q

Etiology & RF for Prematurity

  • Iatrogenic Factors
A

1) Premature induction of labor
2) ECV
3) amniocentesis or surgery.

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21
Q

Etiology & RF for Prematurity

  • Idiopathic
A

In 50% of cases

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22
Q

Etiology & RF for Prematurity

  • Commonest Cause
A

Idiopathic

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23
Q

Importance of Prematurity

A
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24
Q

Complications of Prematurity

A
  • Long term
  • Short term
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25
Complications of **Prematurity** - Long-term
- ↑↑ incidence of underdevelopment. - ↑↑ incidence neurological & intellectual abnormalities later in life.
26
Complications of **Prematurity** - short Term
- Respiratory - Brain - Blood - Metabolic - Others
27
Short term Complications of **Prematurity** - Respiratory
28
Respiratory Complications of **Prematurity** - incidence
Asphyxia accounts for majority of neonatal deaths.
29
Respiratory Complications of **Prematurity** - Causes
30
Brain Complications of **Prematurity** - Incidence
> 10% of prematures
31
Brain Complications of **Prematurity** - Causes
- Hypoprothrombinemia. - Immature vascular bed in germinal matrix prior to 35 weeks gestation. - Softness of skull allows rapid & dangerous moulding.
32
Blood Complications of **Prematurity** - Increased Bilirubin
- liver is unable to conjugate bilirubin from blood sufficiently d2 enzymatic immaturity
33
Blood Complications of **Prematurity** - Anemia
- Due to poor iron stores & slow synthesis of Hb molecule
34
Metabolic Complications of **Prematurity**
35
Metabolic Complications of **Prematurity** - Causes of hypothermia
36
Metabolic Complications of **Prematurity** - Causes of hypoglycemia
Due to poor glycogen stores
37
Metabolic Complications of **Prematurity** - Causes of hypocalcemia
Manifested by clonus, tremors or convulsions
38
Metabolic Complications of **Prematurity** - Kidney Immaturity
Limited ability to excrete solutes in urine
39
Metabolic Complications of **Prematurity** - malnutrition
- Develops easily due to poor suckling & immature digestive & metabolic processes.
40
Metabolic Complications of **Prematurity** - Decreased Resistance to infections
- Due to poor passive immunity (which is usually acquired from mother near term).
41
Dx of **Preterm Labor**
- Prediction - Manifestations of threatened preterm labor - Criteria to document preterm labor
42
Dx of **Preterm Labor** - Prediction
43
Dx of **Preterm Labor** - Manifestations
44
Dx of **Preterm Labor** - Criteria
45
Dx of **Prematurity**
- Before delivery - After delivery (Features of prematurity at birth)
46
Dx of **Prematurity** - Before Delivery
Tests for determination of fetal maturity
47
Dx of **Prematurity** - After Delivery
48
Prevention of **Preterm Labor**
- General - Rest - Cervical Cerclage - Prophylactic tocolytic
49
Prevention of **Preterm Labor** - general Measures
50
Prevention of **Preterm Labor** - rest
In high risk cases as in: - cervical incompetence, multifetal pregnancy. - previous preterm labor, PPROM or after uterine manipulation
51
Prevention of **Preterm Labor** - cervical Cerclage
Done when indicated as in: - cervical incompetence, uterine anomalies - multifetal pregnancy or previous preterm labor
52
Prevention of **Preterm Labor** - tocolytics
Not recommended
53
Managment of **Preterm Labor**
- Bed Rest - Sedatives & narcotics - Tocolytics - Corticosteroides - managment of Delivery - Neonatal Care
54
Managment of **Preterm Labor** - Sedatives & Narcotics
As barbiturates, diazepam & pethidine: ▪ these agents depress preterm infant when administrated to mother near time of delivery
55
Managment of **Preterm Labor** - Bed Rest
Preferably in Lt lateral position to improve uterine blood flow.
56
Managment of **Preterm Labor** - Tocolytics
57
Types of **Tocolytics**
- Short term - Long term
58
Def of **Tocolytics**
Tocolytics are drugs that inhibit uterine contractions.
59
Types of **Tocolytics** - Short term
Indicated to: - Delay labor 2-3 days till achieving max. effect of steroids. - Prevent preterm labor after abdominal or cervical operations or uterine manipulation.
60
**Tocolytics** - If pregnancy is ( ) 34 & 37 weeks
- Decision of tocolysis depends on quality of care available for premature infants & estimated fetal weight
60
Types of **Tocolytics** - Long term
Not effective(oral): - As they stop uterine contractions temporarily but rarely prevent preterm birth
61
CI of **Tocolytics**
62
**Tocolytics** - In cases of PPROM with immature fetus
- Some contraindicate tocolysis in all cases (for fear of chorioamnionitis) while others recommend giving short term tocolysis + prophylactic antibiotics + corticosteroids (to enhance lung maturity) then TOP.
63
**Tocolytics** - Drugs Used
- β-agonists - Magnesium sulfate (MgSO4) - PG synthetase inhibitors (anti-PGs) - Ca++ channel blockers (Nifedepine). - Oxytocin antagonists (atosiban) - Progesterone(17 α-Hydroxyprogesterone caproate) - Others
64
**B-Agonists** in prematurity - Examples
Ritodrine HCL (Yutopar) or Hexoprenaline sulfate (Gynipral)
65
**B-Agonists** in prematurity - Action
inhibition of uterine activity.
66
**B-Agonists** in prematurity - Adminstration
67
**B-Agonists** in prematurity - SE
- Tachycardia, hypotension (due to VD) & arrhythmias. - Pulmonary edema (specially when given e steroids). - Hypokalemia, hyperglycemia & lactic acidosis.
68
**MgSO4** in prematurity - Action
Competes with Ca++ for cellular entry.
69
**MgSO4** in prematurity - Use
The best for diabetic patients
70
**MgSO4** in prematurity - Dose
- 4-6 gm slowly IV over 15-20 minutes then 2 gm/hr by IV drips for 12-24 hours.
71
**MgSO4** in prematurity - SE
See preeclampsia.
72
PG synthetase inhibitors (anti-PGs) in **Prematurity** - exaamples
Indomethacin
73
PG synthetase inhibitors (anti-PGs) in **Prematurity** - Action
74
PG synthetase inhibitors (anti-PGs) in **Prematurity** - SE
Maternal: ▪ Thrombocytopenia & GIT disturbances (peptic ulcers). Fetal: ▪ Premature closure of ductus arteriosus, pulmonary HTN, necrotizing enterocolitis & ICH.
75
Drugs in **Prematurity** - CCBs
Nifedepine
76
Drugs in **Prematurity** - Oxytocin Antagonsits (Atosiban)
Very effective e minimal side effects.
77
Drugs in **Prematurity** - Progesterone(17 α-Hydroxyprogesterone caproate)
Has some value in preventing onset of preterm labor but it is ineffective once labor is established (the drug of choice is)
78
Drugs in **Prematurity** - Others
Diazoxide, ethanol & halothane (anesthetic).
79
Managment of **Preterm Labor** - Corticosteroids
80
Corticosteroids in Managment of **Preterm Labor** - Role
Accelerates lung maturity & ↓↓ incidence of RDS.
81
Corticosteroids in Managment of **Preterm Labor** - Preparations
Dexamethasone or betamethasone (better).
82
Corticosteroids in Managment of **Preterm Labor** - Dose
12 mg/ 12 hrs for 2 doses.
83
Corticosteroids in Managment of **Preterm Labor** - Efficacy
- Peak effect is reached after 48 hours & lasts for 1 week. - Best effect is when given before 30 weeks & least effect is when given after 34 weeks
84
Corticosteroids in Managment of **Preterm Labor** - SE
- Chorioamnionitis, early neonatal sepsis, neonatal death & delayed brain development
85
**Management of delivery (conduct of preterm labor)** - Place
- In well equipped hospital with availability of neonatal intensive care & neonatologist efficient in resuscitative techniques present at delivery room
86
**Management of delivery (conduct of preterm labor)** - Methods
87
**Management of delivery (conduct of preterm labor)** - Vaginal
88
Vaginal Delivery of **Preterm Labor** - During 1st stage
89
Vaginal Delivery of **Preterm Labor** - During 2nd Stage
Important precautions: - Generous episiotomy once head reaches perineum. - Outlet forceps is the only type of forceps allowable. - Ventouse is contraindicated. - No vigorous manipulations
90
Vaginal Delivery of **Preterm Labor** - during 3rd stage
As normal labor.
91
CS Delivery of **Preterm Labor**
92
Neonatal Managmnet of **Pretem Labor**

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