Preterm labor resident survival guide
| Preterm labor Resident Survival Guide Microchapters |
|---|
| Overview |
| Causes |
| Diagnosis |
| Treatment |
| Dos |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
Synonyms and keywords:Preterm delivery, Premature labour, Early delivery, Premature birth, Premature labor, Pre term birth
Overview
Causes
Intra-amniotic infection so far has only been shown to cause preterm delivery.[1] The other factors are being associated based on reports by clinical, epidemiologic, placental pathologic, or experimental studies.Intra-amniotic infections can be subclinical. One in four preterm infants are born due to this cause.[2]
- Infection:
- The most frequent route is the ascending pathway, but hematogenous dissemination can occur.
- Microorganisms are recognized by pattern recognition receptors, such as toll-like receptors (TLRs)
- TLRs stimulate the production of chemokines (IL-8, C-C motif ligand 2 (CCL2), etc.), cytokines (IL-1b, TNF-a, etc), prostaglandins and proteases which activate the quiescent myometrium and stimulates parturition.[2]
- In 30% of cases of intra-amniotic infection, bacteria can be found in the fetal circulation which causes fetal systemic inflammatory response. These fetuses are at risk for long-term complications, such as cerebral palsy and chronic lung disease, which emphasizes that these complications may not only occur due to immaturity but also inflammatory response.[2]
- Uterine ovedistension
- Decidual senescence
- Vascular disorders
- Stress
- Cervical disease
- Decline in progesterone action[3]
- Breakdown in maternal-fetal tolerance.
- Placental abruption, placenta previa
- Smoking[4]
- Maternal age <18 or >40 [5]
- Poor nutrition, low body mass index
- Fetal anomaly[6]
- Fetal growth restriction, oligohydramnios, polyhydramnios
- Vaginal bleeding[7]
- Premature preterm rupture of membranes (PPROM)[8]
- Environmental factors
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Dos
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Romero R, Gómez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim YM (July 2001). "The role of infection in preterm labour and delivery". Paediatr Perinat Epidemiol. 15 Suppl 2: 41–56. doi:10.1046/j.1365-3016.2001.00007.x. PMID 11520399.
- ↑ 2.0 2.1 2.2 Romero R, Dey SK, Fisher SJ (2014). "Preterm labor: one syndrome, many causes". Science. 345 (6198): 760–5. doi:10.1126/science.1251816. PMC 4191866. PMID 25124429.
- ↑ Condon JC, Hardy DB, Kovaric K, Mendelson CR (April 2006). "Up-regulation of the progesterone receptor (PR)-C isoform in laboring myometrium by activation of nuclear factor-kappaB may contribute to the onset of labor through inhibition of PR function". Mol Endocrinol. 20 (4): 764–75. doi:10.1210/me.2005-0242. PMID 16339279.
- ↑ Wisborg K, Henriksen TB, Hedegaard M, Secher NJ (August 1996). "Smoking during pregnancy and preterm birth". Br J Obstet Gynaecol. 103 (8): 800–5. doi:10.1111/j.1471-0528.1996.tb09877.x. PMID 8760711.
- ↑ Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F (2018). "Effect of maternal age on the risk of preterm birth: A large cohort study". PLoS One. 13 (1): e0191002. doi:10.1371/journal.pone.0191002. PMC 5791955. PMID 29385154.
- ↑ Craigo SD (October 2011). "Indicated preterm birth for fetal anomalies". Semin Perinatol. 35 (5): 270–6. doi:10.1053/j.semperi.2011.05.011. PMID 21962626.
- ↑ Hossain R, Harris T, Lohsoonthorn V, Williams MA (December 2007). "Risk of preterm delivery in relation to vaginal bleeding in early pregnancy". Eur J Obstet Gynecol Reprod Biol. 135 (2): 158–63. doi:10.1016/j.ejogrb.2006.12.003. PMC 2726845. PMID 17207901.
- ↑ Gomez R, Romero R, Edwin SS, David C (March 1997). "Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection". Infect Dis Clin North Am. 11 (1): 135–76. doi:10.1016/s0891-5520(05)70347-0. PMID 9067790.