This document discusses preterm birth and low birth weight. It defines key terms like preterm, low birth weight, very low birth weight and extremely low birth weight according to various medical organizations. It examines causes of preterm birth like infection, stress, hemorrhage and uterine distention. Complications of preterm birth are outlined like respiratory distress syndrome and intraventricular hemorrhage. Diagnosis, management and prevention of preterm birth are also summarized.
This document discusses preterm birth and low birth weight. It defines key terms like preterm, low birth weight, very low birth weight and extremely low birth weight according to various medical organizations. It examines causes of preterm birth like infection, stress, hemorrhage and uterine distention. Complications of preterm birth are outlined like respiratory distress syndrome and intraventricular hemorrhage. Diagnosis, management and prevention of preterm birth are also summarized.
This document discusses preterm birth and low birth weight. It defines key terms like preterm, low birth weight, very low birth weight and extremely low birth weight according to various medical organizations. It examines causes of preterm birth like infection, stress, hemorrhage and uterine distention. Complications of preterm birth are outlined like respiratory distress syndrome and intraventricular hemorrhage. Diagnosis, management and prevention of preterm birth are also summarized.
This document discusses preterm birth and low birth weight. It defines key terms like preterm, low birth weight, very low birth weight and extremely low birth weight according to various medical organizations. It examines causes of preterm birth like infection, stress, hemorrhage and uterine distention. Complications of preterm birth are outlined like respiratory distress syndrome and intraventricular hemorrhage. Diagnosis, management and prevention of preterm birth are also summarized.
live born infant ≤ 2500 gr ACOG (1995) Preterm birth < 37 weeks Low birth weight : infants who are born to small Preterm/premature birth : infants who are born to soon Definition World Health Organization (WHO, 1993) : Preterm : gestasional age of less than 37 completed weeks (259 days) from the first day of the last menstrual period Very premature fetus ( delivery at 24 – 29.9 weeks) Moderately premature fetuses ( delivery at 30 – 36.9 weeks) SIZE Normally grown (appropriate for gestational age) Small for gestational age (< 10th percentile) Large for gestational age ( > 90th percentile) Intrauterine growth restriction
Preterm could be small or large for gestational age
Some preterm also suffered growth restriction in utero BIRTH WEIGHT (WHO)
Low birth weight < 2500 g
Very low birthweight < 1500 g Extremely low birthweight < 1000 g CURRENT DEFINITIONS Birth weight Low birth weight (LBW) < 2500 g Very Low birth weigh (VLBW) < 1500 g Gestation lenght Premature (preterm delivery, PTD) < 37 weeks Early pretem delivery < 32 weeks Growth restriction < 10th percentile for gestational age IUGR : intrauterine growth restriction applies to fetuses SGA : small for gestational age applies to neonate Pathways to preterm birth Inflammation Infection : 40% Activation of the maternal-fetal-hypothalamic- pituitary-adrenal (HPA) axis Stress : 30% Decidual hemorrhage Abruption : 20% Uterine distention Stretching : 10% Stratifikasi risiko dan mekanisme patologis pada persalinan premature. (Lockwood CJ dan Kuczynski, 2001) Three main condition explain preterm birth Medically indicated (iatrogenic) : 25%
Preterm premature rupture of membranse
(PPROM) : 25%
Spontaneous (idiopathic) : 50%
Infection Sexually transmitted infections Bacterial vaginosis Genitoury infections Asymptomatic bacteriuria Pyelonephritis Pneumonia Peritonitis Periodontal disease Stress and lifestyle PROBLEMS Perinatal mortality Serious neonatal morbidity Moderate to severe childhood disability COMPLICATION Respiratory distress syndrome Bleeding in the brain : intraventricular hemorrhage (IVH) Patent ductus arteriosus Necrotizing enterocolitis (NEC) Retinopathy of prematurity (ROP) DIAGNOSIS Sign & symptoms Painful uterine contraction Progressive dilatation and effacement of the cervix USG Cervical lenght Fetal fibronectin Intracellular adhesion Stromal remodelling of the cervix prior labor Bacterial vaginosis (BV) Lactobacillus vaginalis replaced with anaerobic bacteria Gardnerella vaginalis, Mobiluncus species, mycoplasma hominis MANAGEMENT Tocolytic Tarbutaline‘ Magnesium sulfate Indomethacin Nifedipine Corticosteroids : < 32 weeks , to promote fetal lung maturation PREVENTION Identification of risk factors Adequate rest Nutritional supplement Avoidance smoking Circlage operation Progesterone High risk women