Preterm Labor
Preterm labor (PTL)
1. cause of precipitating factors of preterm birth
2. ±âº»ÀûÀÎ °í·Á »çÇ×
1) gestational age
2) ROM À¯¹«
3) fever À¯¹« (chorioamnionitis)
3. ÀÓ»ó ¼Ò°ß (Á¶»êÀÌ ÀÓ¹ÚÇßÀ½À» ¾Ë¸®´Â ¼Ò°ßµé)
- Ut. contractions/bleeding
- menstrual-like cramp
- pelvic pressure
- back pain
- ROM
- watery vaginal discharge, vaginal spotting
4. P/E
1) abdominal
- Ut. tenderness ¡æ chorioamnionitis ÀǽÉ
- Ut. irritability ¡æ abruptio placentae ÀǽÉ
2) pelvic
¨ç external genitalia & vagina
- watery discharge or pooling of fluid in the vagina ¡æ ROM ÀǽÉ
- vaginal bleeding ¡æ abruptio placentae or placenta previa ÀǽÉ
- bloody show ¡æ cervical dilatation & effacement ½Ã»ç
¨è cervix
- cervical dilatation & effacement
- presenting part, station of the presenting part
¨é uterus & adnexa
- Ut. contraction (may be palpable)
- tender ¡æ chorioamnionitis ÀǽÉ
- tender & irritable ¡æ abruptio placentae ÀǽÉ
5. ¿¹Ãø ¹× Áø´Ü
1) À§Çèµµ ¿¹Ãø
¨ç previous history of preterm birth
¨è ÀӽŠÁß±â ÀÌÈÄÀÇ ¹«Áõ»ó Àڱà °æºÎ °³´ë½Ã
¨é Ut. contractions/bleeding, menstrual-like cramp, pelvic pressure, vaginal discharge µîÀº Á¶»êÀÌ ÀÓ¹ÚÇßÀ½À» ½Ã»çÇÏ´Â ¼Ò°ßÀ̹ǷΠÁÖÀÇ ±í°Ô °üÂû
¨ê fetal fibronectin : cervicovaginal secretion¿¡¼ PTLÀ» ¿¹ÃøÇϴ ǥ½ÄÀڷμ ÀÇ¹Ì ÀÖÀ½
(ELISA·Î ÃøÁ¤, >500ng/ml ÀÌ¸é ¾ç¼º)
¨ë tocomonitoring : regular ut. contraction
2) Áø´Ü (criteria of PTL)
- ÀӽŠ20~37Áß¿¡ 5~8ºÐ °£°ÝÀÇ regular ut. contraction (+ ´ÙÀ½ Áß Çϳª)
¤ý progressive change of cervix
¤ý cervical dilatation > 2cm
¤ý cervical effacement > 80%
6. antepartum management
1) Mx ¿øÄ¢
¨ç ROM (+) ¡æ PROM óġ¿¡ ÁØÇؼ Ä¡·á
¨è ROM (-) ¡æ 35ÁÖ ÀÌÀü¿¡ ºÐ¸¸µÇ´Â °ÍÀ» ÇÇÇÔ
2) method
¨ç steroid
- Ix : PA 24~31wksÀÇ Á¶»ê À§Ç輺ÀÌ ÀÖ´Â PTL ÀӽźΠ¹× PROM ÀӽźÎ
- ¾à¹° : dexamethasone 5mg/12hr (ÀÏÁÖÀÏ À̳»¿¡ Á¶»êÇÏÁö ¾Ê´Â °æ¿ì 1ÁÖ¸¶´Ù ¹Ýº¹ Åõ¿©)
¨è phenobarbital & vitamin K ¡æ IVH °¨¼Ò
¨é ÀڱðæºÎ ºÀÃà¹ý (cerclage)
- tocolytics »ç¿ë°ú ÀÔ¿ø ±â°£À» ¿¬Àå½ÃŰ¹Ç·Î, Á¶»ê °æ·ÂÀÌ 3ȸ ÀÌ»óÀÎ °æ¿ì¸¸ ½ÃÇà
¨ê bacterial vaginosisÀÇ Ä¡·á
3) ÀϹÝÀûÀÎ Mx ¼ø¼
¨ç bedrest ¡æ external toco monitoring & FHR monitoring
¨è IV fluid hydration
¨é tocolytic medication
¨ê corticosteroid
¨ë ±âŸ PTL ¿øÀο¡ µû¸¥ Mx
7. PTL ¾ïÁ¦ ¹æ¹ý
1) bed rest : left lateral decubitus position
2) tocolytics
¨ç ¥â-agonist (ritodrine, terbutaline, fenoterol µî)
- C/Ix : heart ds, DM, PIH, severe anemia, FGR, intrauterine infection
- Cx : hyperglycemia, hypokalemina, hypotension, pulmonary edema, cardiac insufficiency, myocardial ischemia, arrhythmia
¨è magnesium sulfate
- ±âÀü : calcium antagonist·Î °íÇ÷Á߳󵵿¡¼ Àڱà ¼öÃà ¾ïÁ¦
- Cx : pulmonary edema, respiratory depression, cardiac arrest, maternal tetany, hypotension, muscular paralysis
¨é calcium channel blocker (nifedipine)
- transient hypotension
¨ê indomethacin (long-term use ½Ã)
- Cx : hepatitis, renal failure, GI bleeding
1. cause of precipitating factors of preterm birth
2. ±âº»ÀûÀÎ °í·Á »çÇ×
1) gestational age
2) ROM À¯¹«
3) fever À¯¹« (chorioamnionitis)
3. ÀÓ»ó ¼Ò°ß (Á¶»êÀÌ ÀÓ¹ÚÇßÀ½À» ¾Ë¸®´Â ¼Ò°ßµé)
- Ut. contractions/bleeding
- menstrual-like cramp
- pelvic pressure
- back pain
- ROM
- watery vaginal discharge, vaginal spotting
4. P/E
1) abdominal
- Ut. tenderness ¡æ chorioamnionitis ÀǽÉ
- Ut. irritability ¡æ abruptio placentae ÀǽÉ
2) pelvic
¨ç external genitalia & vagina
- watery discharge or pooling of fluid in the vagina ¡æ ROM ÀǽÉ
- vaginal bleeding ¡æ abruptio placentae or placenta previa ÀǽÉ
- bloody show ¡æ cervical dilatation & effacement ½Ã»ç
¨è cervix
- cervical dilatation & effacement
- presenting part, station of the presenting part
¨é uterus & adnexa
- Ut. contraction (may be palpable)
- tender ¡æ chorioamnionitis ÀǽÉ
- tender & irritable ¡æ abruptio placentae ÀǽÉ
5. ¿¹Ãø ¹× Áø´Ü
1) À§Çèµµ ¿¹Ãø
¨ç previous history of preterm birth
¨è ÀӽŠÁß±â ÀÌÈÄÀÇ ¹«Áõ»ó Àڱà °æºÎ °³´ë½Ã
¨é Ut. contractions/bleeding, menstrual-like cramp, pelvic pressure, vaginal discharge µîÀº Á¶»êÀÌ ÀÓ¹ÚÇßÀ½À» ½Ã»çÇÏ´Â ¼Ò°ßÀ̹ǷΠÁÖÀÇ ±í°Ô °üÂû
¨ê fetal fibronectin : cervicovaginal secretion¿¡¼ PTLÀ» ¿¹ÃøÇϴ ǥ½ÄÀڷμ ÀÇ¹Ì ÀÖÀ½
(ELISA·Î ÃøÁ¤, >500ng/ml ÀÌ¸é ¾ç¼º)
¨ë tocomonitoring : regular ut. contraction
2) Áø´Ü (criteria of PTL)
- ÀӽŠ20~37Áß¿¡ 5~8ºÐ °£°ÝÀÇ regular ut. contraction (+ ´ÙÀ½ Áß Çϳª)
¤ý progressive change of cervix
¤ý cervical dilatation > 2cm
¤ý cervical effacement > 80%
6. antepartum management
1) Mx ¿øÄ¢
¨ç ROM (+) ¡æ PROM óġ¿¡ ÁØÇؼ Ä¡·á
¨è ROM (-) ¡æ 35ÁÖ ÀÌÀü¿¡ ºÐ¸¸µÇ´Â °ÍÀ» ÇÇÇÔ
2) method
¨ç steroid
- Ix : PA 24~31wksÀÇ Á¶»ê À§Ç輺ÀÌ ÀÖ´Â PTL ÀӽźΠ¹× PROM ÀӽźÎ
- ¾à¹° : dexamethasone 5mg/12hr (ÀÏÁÖÀÏ À̳»¿¡ Á¶»êÇÏÁö ¾Ê´Â °æ¿ì 1ÁÖ¸¶´Ù ¹Ýº¹ Åõ¿©)
¨è phenobarbital & vitamin K ¡æ IVH °¨¼Ò
¨é ÀڱðæºÎ ºÀÃà¹ý (cerclage)
- tocolytics »ç¿ë°ú ÀÔ¿ø ±â°£À» ¿¬Àå½ÃŰ¹Ç·Î, Á¶»ê °æ·ÂÀÌ 3ȸ ÀÌ»óÀÎ °æ¿ì¸¸ ½ÃÇà
¨ê bacterial vaginosisÀÇ Ä¡·á
3) ÀϹÝÀûÀÎ Mx ¼ø¼
¨ç bedrest ¡æ external toco monitoring & FHR monitoring
¨è IV fluid hydration
¨é tocolytic medication
¨ê corticosteroid
¨ë ±âŸ PTL ¿øÀο¡ µû¸¥ Mx
7. PTL ¾ïÁ¦ ¹æ¹ý
1) bed rest : left lateral decubitus position
2) tocolytics
¨ç ¥â-agonist (ritodrine, terbutaline, fenoterol µî)
- C/Ix : heart ds, DM, PIH, severe anemia, FGR, intrauterine infection
- Cx : hyperglycemia, hypokalemina, hypotension, pulmonary edema, cardiac insufficiency, myocardial ischemia, arrhythmia
¨è magnesium sulfate
- ±âÀü : calcium antagonist·Î °íÇ÷Á߳󵵿¡¼ Àڱà ¼öÃà ¾ïÁ¦
- Cx : pulmonary edema, respiratory depression, cardiac arrest, maternal tetany, hypotension, muscular paralysis
¨é calcium channel blocker (nifedipine)
- transient hypotension
¨ê indomethacin (long-term use ½Ã)
- Cx : hepatitis, renal failure, GI bleeding