Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy

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Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy. Women Hospital , School of Medical, ZheJiang University Yang Xiao Fu. Preterm labour. Preterm labour. - PowerPoint PPT Presentation

Text of Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy

  • Premature Delivery Premature Rupture of MembraneProlonged Pregnancy, Multiple PregnancyWomen Hospital , School of Medical, ZheJiang University Yang Xiao Fu

  • Preterm labour

  • Preterm labourDefined as delivery after gestation 28 completed weeks till 37 weeks (196-258 days). Birth weight 1000g - 2449gPreterm labour makes up 5% - 15% of total number of deliveryCan the lower limit of preterm labour be brought earlier to 20 weeks gestation?

  • Diagnosis of preterm labourLabour occurring between gestation 28 completed weeks and 37 weeksregular uterine contraction: 4 times in 20 minutes or 8 times in 60 minutescervical shortening of 75%progressive cervical dilatation of 2cm and above

  • Prediction of preterm labourUltrasound assessing cervical length and internal os funnel formation, when internal os funnel is longer than the total cervical length by 25%, or total cervical length
  • Prediction of preterm labourFetal fibronectine (fFN), after 20 weeks gestation fFN>50ng/ml, indicates possibility of preterm labour. Its sensitivity is up to 93%, specificity 82%

  • Premature rupture of membrane

  • Premature rupture of membraneMembrane rupture occurring before labour, known as premature rupture of membrane (PROM)Occurring after 37 completed weeks gestation, is called premature rupture of membrane at termOccurring before 37 weeks gestation, called preterm premature rupture of membrane (PPROM)

  • Effect to mother and fetusFeto-maternal infectionPlacenta abruptioPremature infant: 30% - 40% of premature labour is associated with premature rupture of membraneCord prolapse, cord compressionPoor fetal lung development and fetal compression syndrome

  • Post-term pregnancyProlonged pregnancy

  • Prolonged pregnancyGestation at or beyond 42 weeks gestation (>=294 days), known as post-term pregnancyImportant factor for fetal distress, meconium aspiration syndrome, maturation disturbance syndrome, newborn asphysia, perinatal death, macrosomia and dystocia

  • DiagnosisDetermine gestational ageCalculation based on last menstrual periodCalculation based on ovulationUltrasound examination to ascertain gestation agePeriod of manifestation of early pregnancy symptoms, quickening First trimester pelvic examination assessing uterine size

  • Diagnosis Assess placental functionFetal movement countFetal electronic monitoringFetal biophysical profile (Ultrasound)Urine E/C
  • Management Prevent post-term labour, effectively manage at term Decide appropriate mode of delivery based on integrated analysis of placental function, estimated fetal weight, cervical effacement, etc Induced labourCaesarean sectionNeonatal resuscitation

  • Multiple pregnancy

  • Multiple pregnancyConception of 2 or more fetuses in the same intra-uterine pregnancy Incidence of multiple pregnancy: 1:80n-1 (n represents number of fetus in a single pregnancy)

  • Dizygotic twinDizygotic twin makes up 70% of twin pregnancyAssociated with ovulation induction, multi-embryo intrauterine transplantation and genetic factorsTwo separate ova being fertilized forming two zygotes, each genetic compositions is not identical, hence the differences in both fetuses

  • Dizygotic twinThe placentas are usually dichorionic, can be fused together, but each has own independent blood circulationTwo amniotic cavities are seen at the fetal surface of placenta, two layers of amniotic membrane and two layer of chorionic membrane present within

  • Monozygotic twinMonozygotic twin makes up approximately 30% of twin pregnancyUnclear cause, higher incidence in older pregnant womenSingle fertilized ovum differentiating into two fetuses, thus gender, blood type and other phenotypes are identicalAs the fertilized ovum differentiates at different times, forming 4 types

  • Diamniotic dichorionic monozygotic twinDifferentiate within 72 hours of fertilizationForm two independent fertilized ova and two amniotic sac, two layers of chorionic membranes and two layers amniotic membranes within the amniotic sacsMaybe single or two placentasMakes up approximately 30% of monozygotic twins

  • Diamniotic monochorionic monozygotic twinDifferentiation occurs from 72 hours to 8 days of fertilizationOne layer of chorionic membranes and Two layers of amniotic membranes within two amniotic sacsSingle placentaMakes up 68% of monozygotic twins

  • Monoamniotic monochorionic monozygotic twinDifferentiation within 9-13 days after fertilizationBoth fetuses share a single amniotic cavitySingle placentaMakes up 1% - 2% of monozygotic twins

  • Conjoined twinDifferentiation after 13 days of fertilization, during which the primitive embryo has formed, the body cannot completely differentiate into two separate bodies, thus leading to different types of conjoined twinsIncidence is 1/1500 of monozygotic twins

  • Conjoined twin