PRETERM LABOR AND BIRTH

INTRODUCTION: Preterm labor is defined as the presence of regular uterine contractions that occur before 37 completed weeks of gestation and are associated with cervical changes. It is often difficult to diagnose preterm labor because of the absence of definitive measurements. Preterm birth is delivery that occurs prior to the completion of 37 completed weeks or an equivalent of 259 days of gestation. Because it is the most common cause of perinatal morbidity and mortality in many countries, prevention and treatment of preterm birth is one of the major focus of obstetric care.

COMPLICATIONS OF PRETERM BIRTH: In addition to perinatal death in the very young fetus, common complications of preterm birth include respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neurologic impairment, and seizures. Long-term morbidity associated with preterm delivery includes bronchopulmonary dysplasia and developmental abnormalities, including cerebral palsy.

CLASSIFICATION: Preterm births may be classified into two general presentations: Spontaneous and indicated. Approximately 50% of preterm births result from spontaneous preterm labor with intact membranes; around 40% result from preterm premature rupture of membranes. The remaining more than 10% occur following deliberate intervention for a variety of maternal or obstetric complications such as, eclampsia.

CAUSE OF PRETERM LABOR: Preterm labor may represent a final common pathway for a number of pathogenic processes. The four main processes include;

(1) activation of the maternal or fetal hypothalamic–pituitary–adrenal axis due to maternal or fetal stress,

(2) decidual–chorioamniotic or systemic inflammation caused by infection,

(3) decidual hemorrhage, and

(4) pathologic uterine distention.

FACTORS ASSOCIATED WITH PRETERM LABOR

1. Prior history of preterm birth

2. Preterm uterine contractions

3. Premature rupture of membranes

4. Behavorial risk factors: Low maternal pregnancy, weight, Smoking, Substance abuse, Short interpregnancy interval

5. Current pregnancy factors: Short cervical length, Multifetal gestation, Vaginal bleeding, Urinary tract infections, Genital tract infection and Periodontal disease

RELATED;

1.  PREGNANCY AND CHILDBIRTH

2.  PARTURITION AND LABOR

3.  DRUGS USED IN LABOR

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