DIFFERENTIAL

DIAGNOSIS
 PLACENTAL ABRUPTION
RULE IN:
• Abdominal pain
either
• Vaginal spotting
• Third trimester of pregnancy
RULE OUT:
Separation of the placenta
Common partially or totally
in multiparous womenfrom
itsuterine
(-) implantation
tendernesssite before
(-) history ofdelivery.
prior abruption
(-) history of trauma
(-) hypertension
(-) smoking, cocaine abuse
(-) fetal distress
 PRE-ECLAMPSIA
DIAGNOSTIC CRITERIA OF PRE-ECLAMPSIA BY ACOG

BLOOD PRESSURE
 ≥140mmHg systolic or ≥90mmHg diastolic on two occasions at least 4 hours apart
after 20 weeks AOG in a woman with a previously normal blood pressure
 ≥160mmHg systolic or ≥110mmHg diastolic, severe hypertension can be confirmed
within a short interval (minutes) to facilitate timely antihypertensive therapy

PROTEINURIA
or in the absence of proteinuria , new-onset hypertension
with the new onset of any of the following:
 ≥300 mg/24 hour-urine collection
 Thrombocytopenia
 Protein/creatinine ratio ≥0.03mg/dl
 Renal insufficiency
 Dipstick reading of 1+
 Impaired liver function:
 Pulmonary edema
 Cerebral or visual symptoms
 PRE-ECLAMPSIA
RULE IN: RULE OUT:
• Abdominal pain Epigastric or RUQ pain
(-) headache
• First pregnancy (-) dizziness, blurring of vision
(-) nausea or vomiting
(-) dyspnea
(-) history of hypertension
(-) diabetes
(-) fetal distress
URINARY TRACT INFECTION
RULE IN: RULE OUT:
UTI may be asymptomatic (subclinical
infection) or symptomatic (disease).
(-) dysuria,
the termurinary
urinaryfrequency or
tract infection
• Pregnant woman Thus,
urgency a variety of clinical entities,
encompasses
• History of UTI (-) suprapubic pain and tenderness
including asymptomatic bacteriuria
(-) flank pain
• Abdominal pain (ASB), cystitis, and pyelonephritis.
(-) fever, chills, costovertebral angle
tenderness
(-) malaise, anorexia, nausea,
vomiting
CERVICAL INSUFFICIENCY
RULE IN: RULE OUT:

• Cervical dilatation (-) No preterm premature rupture of

membrane
• Vaginal spotting (+) Contractions every 12-15 mins.
(mild-moderate)
 PLACENTA PREVIA
RULE IN:
Placenta previa refers to the
• Cervical dilatation presence of placental tissue
that extends over the internal
• Vaginal spotting cervical os (partially or
completely).
 Disrupted Placental
Attachment

Uterus Can’t Contract

Adequately
CANNOT BE RULED-OUT Risk for preterm
labor
Bleeding at Implantation
Site

Release of Thrombin Uterine contraction

 PRETERM LABOR
The American College of RULE IN:
Obstetricians and
Gynecologists (2016b) define • 29 weeks AOG
preterm labor to be regular • Abdominal pain
contractions before 37 weeks • Vaginal spotting
that are associated with • Cervical dilatation
cervical change. • Uterine contractions
 PRETERM LABOR
ETIOLOGY

DIAGNOSIS
 Symptoms
 Physical Examination
 Sonography is used to
identify asymptomatic
cervical dilation and
effacement
 PRETERM LABOR
Gestational Age
• 20 weeks gestation and < 37 days completed weeks gestation

Uterine Activity
• Preterm labor, as opposed to “false” labor, is differentiated by contractions that are (1)
regular, (2) frequent, (3) may or may not be painful, that result in cervical dilation and
effacement.
Traditional criteria: persistent uterine contractions
accompanied by dilatation and/or effacement of the cervix Note: There is a need to consider the
• contraction frequency is 6 or more per hour diagnosis of “Threatened preterm labor,”
• cervical dilatation is 3 cm or greater wherein a criteria for diagnosis are not
fulfilled but somehow “active”
• effacement is 80% or greater
intervention maybe warranted.
• membranes rupture or bleeding occurs
 PRETERM LABOR
Assessment of Effects of Uterine Activity

Cervical Evaluation TRANSVAGINAL SONOGRAPHY

DIGITAL CERVICAL EXAMINATION

Biochemical Markers
FETAL FIBRONECTIN (FFN) TEST

Clinical Markers for High Risk Ruptured Membranes, Vaginal Bleeding,

Imminent Preterm Labor Cervical Dilatation Beyond 2 cm
 PRETERM LABOR
MANAGEMENT
CORTICOSTEROID THERAPY • For preterm labor with intact
• prolong
Because theoftime its to neuroprotective
delivery so that
membranes, antibiotic
antenatal
• Most
effect, corticosteroids
administration
effective of and
antenatal
intervention to
MAGNESIUM SULFATE administration reduces maternal
potentially
magnesium
improve magnesium
newborn sulfateoutcomessulfate
has been can
for
infectious morbidity. However, no
be administered,
associated
patients in with
preterm anda
labor the mother can
decrease in
clear overall benefit on neonatal
be transferred
occurrence and to a tertiary
severity care
of cerebral
TOCOLYSIS outcomes
facility
• Reduction
has
with
palsy in infants.
been demonstrated.
a neonatal
in neonatal intensive
deaths, RDS,
care unit.
• cerebroventricular
Antibiotic administrationhemorrhage,reduces NEC,
ANTIBIOTICS • respiratory
Use magnesium sulfate
support, for only 24-
intensive care
maternal and fetal infections and
• admissions
Calcium
48 hours to
and channel
allow time
systemic for blockers
steroid
infections in
inhibit subclinical infection and
(Nifedipine),
administration
the first 48 hours Progesterone,
andlife
of transfer COX-2
to a
subsequent preterm labor.
inhibitorscenter.
tertiary (Indomethacin),
Discontinueoxytocinonce
receptor
these antagonists
goals are achieved(Atosiban)
or if labor
subsides.