P N FATHIMA BEEVI

MBBs 3rd Year

HIMSR,NEW DELHI

PRETER
M
PRETERM Labor
Onset of labor prior to the
completion of 37 weeks or 259
days of gestation counting from
the first day of last menstruation
period.

Lower limit
- 20 weeks in developed countries
- 28 weeks in developing countries
 Threatened Preterm Labor
Uterine contractions perceived in
the absence of cervical changes

Preterm birth – leading

cause of neonatal morbidity and
mortality.
Incidence : 5 -18% in different
parts of world and India
Etiology :Risk factors and Causes
Pregnancy Multiple Infarction
Maternal factors
complications pregnancy

Placental factors
Thrombosis

Fetal factors
Uterine Congenital Placenta previa
anomalies malformations
Abruption
Medical and Intrauterine
Surgical illness Death
Genital tract Fetal distress
infections IUGR
 Socioeconomic
History Iatrogenic Idiopathic
factors
• Recurrent • Lower • Indicated • Premature
abortions socioeconomic preterm labor activation of
• Previous status due to same systems
preterm • Smoking medical or involved in
delivery • Increased obstetric initiating
physical complications labor at term
activity
• Underweight
Activation of Infection Decidual Pathologic
Maternal-Fetal -choriodecidual Hemorrhage Uterine
HPA axis Distension

Chorion
Amnion
Decidua

Proteases Uterotonins

Preterm premature Uterine contractions

rupture of membranes Cervical Changes

Preterm Labor and Delivery

Sympto
Diagnos
ms
is
Effacem
Cervic
al Uterine
contracti
Length
ent (80%) dilatati ons (4
of on in 20 mins)
cervix (≥2cm)
(≤2.5cm
)
 Uterine
Symptoms
activity

Pelvic
pressure
Menstrual like Blood stained
cramps vaginal
discharge
Lower back Watery
pain vaginal
discharge