PRETERM BIRTH

Dr. Deviana S. Riu, SpOG

 Preterm
Prematurity
Low birth weight

 American Academy of Pediatrics (1935)

 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
Thank You
Thank You