WHO defines preterm infants as babies born alive before the 37th week of pregnancy. Preterm birth is divided into subcategories depending on gestational age, early premature (less than 28 weeks) extremely premature (28 to 32 weeks). Mild to late preterm (32 to 37 weeks). Preterm birth is a multifaceted dilemma that involves various interrelated factors.
These include individual social, behavioral, and psychological factors, medical conditions, environmental exposures, fertility treatments, biological influences, and genetics. Often, these factors coincide, particularly in individuals who are economically disadvantaged or belong to ethnic and racial minority groups. Preterm labor refers to childbirth between 20 weeks and 36 weeks of gestation, with early preterm birth being defined as birth before 33 weeks and late preterm birth as birth between 34 and 36 weeks.
Epidemiology
The rate of preterm births in the United States has been steadily increasing over the past decade. In 2004, 12.5% of births occurred before 37 completed weeks of gestation. Unfortunately, there are significant disparities in the rates of preterm birth based on race, ethnicity, and socioeconomic status. African American women have the highest rates, while Pacific Islander and Asian women have the lowest rates. In 2003, the rate for African American women was 17.8%, compared to 10.5% for Asian and Pacific Islander women and 11.5% for white women.
Notably, the rates for American Indian, white non-Hispanic, and Hispanic groups have been increasing since 2001. Babies born prematurely are at a greater risk of mortality and developmental problems. These complications can include the respiratory, immunologic, gastrointestinal, central nervous system, hearing, and vision systems, as well as longer-term problems with motor skills, vision, cognition, behavior, hearing, social-emotional development, health, and growth.
The impact of preterm birth can also have a significant financial and emotional impact on families. It can strain public-sector services such as health insurance, education, and social support systems. In 2005, the societal and economic burden associated with preterm birth in the US was at least $26.2 billion. While infants born at the earliest gestational ages are at the highest risk for mortality and morbidity, most preterm births occur closer to term and still experience more complications than full-term infants.
Anatomy
Pathophysiology
Labor involves three primary components: persistent uterine contractions, cervical changes and activation of the membranes and decidua. While labor at term occurs via a normal physiologic activity, preterm labor is pathological and can result from acute or chronic processes that occur weeks before the onset of labor. One of the key pathological events in preterm labor is fetal inflammatory response syndrome (FIRS), which triggers systemic inflammation and elevates fetal plasma interleukin-6 levels. FIRS is often triggered by chorioamnionitis.
It stimulates the release of corticotropin-releasing hormone by the fetal hypothalamus, leading to the secretion of adrenocorticotropic hormone (ACTH) and cortisol production by the fetal adrenal glands. This activates the parturition pathway and leads to the incursion of inflammatory cells into the cervical stroma, which releases cytokines and prostaglandins that stimulate cervical ripening. Cervical ripening involves changes in the collagen and glycosaminoglycan structures that make up cervical tissue.
Estrogen stimulates collagen degradation, while progesterone inhibits it. Consequently, progesterone is often used to prevent or delay cervical ripening. Both hormones are also implicated in regulating the formation of gap junctions and the upregulation of connexin 43 proteins, which contribute to parturition. Uterine contractions are also essential for labor, and the transition from uncoordinated to coordinated contractions is attributed to neural control.
Oxytocin plays a vital role in regulating the circadian rhythm of uterine contractions. The degradation of the extracellular matrix is assessed by detecting fetal fibronectin in cervicovaginal secretions, which is also a part of the parturition process. Detection of fetal fibronectin between 22 and 37 weeks of gestational age indicates the disruption of the decidual-chorionic interface and an increased risk of preterm labor.
Etiology
Preterm birth, defined as delivery before 37 completed weeks of gestation, is a significant cause of neonatal morbidity and mortality worldwide. It is often associated with maternal medical conditions such as chronic hypertension, gestational diabetes mellitus, and systemic lupus erythematosus.
These conditions can alter placental function, resulting in fetal growth restriction and increasing the risk of preeclampsia, which can lead to indicated preterm birth. Other factors such as maternal underweight or obesity, a family history of preterm birth, and short interpregnancy intervals can also increase the risk of preterm birth. Assisted reproductive technologies, which often result in multiple gestations, are also associated with a higher risk of preterm delivery.
Indicated for Fetal neuroprotection for imminent preterm birth:
Intravenous (IV)
Initial dose:4g of loading dose for 20 to 30 minutes
Maintenance dose:1 gram per hour via continuous intravenous infusion
The maintenance infusion can be continued for up to 24 hours or until delivery, whichever occurs first
Initial dose: 50 to 100 mcg intravenously (IV) per minute, increased as necessary by increments of 50 mcg every ten minutes to the dosage that balances uterine response and undesirable effects (increased maternal heart rate, decreased blood pressure, and increased fetal heart rate), or until the maternal heart rate reaches 130 beats per minute
Maintenance dose: The lowest dosage that keeps the uterus relaxed is 150 to 350 mcg intravenously each minute. ritodrine should be stopped if labor is uncontrollable or the maximum dose of 350 mcg per minute is reached, and labour continues
WHO defines preterm infants as babies born alive before the 37th week of pregnancy. Preterm birth is divided into subcategories depending on gestational age, early premature (less than 28 weeks) extremely premature (28 to 32 weeks). Mild to late preterm (32 to 37 weeks). Preterm birth is a multifaceted dilemma that involves various interrelated factors.
These include individual social, behavioral, and psychological factors, medical conditions, environmental exposures, fertility treatments, biological influences, and genetics. Often, these factors coincide, particularly in individuals who are economically disadvantaged or belong to ethnic and racial minority groups. Preterm labor refers to childbirth between 20 weeks and 36 weeks of gestation, with early preterm birth being defined as birth before 33 weeks and late preterm birth as birth between 34 and 36 weeks.
The rate of preterm births in the United States has been steadily increasing over the past decade. In 2004, 12.5% of births occurred before 37 completed weeks of gestation. Unfortunately, there are significant disparities in the rates of preterm birth based on race, ethnicity, and socioeconomic status. African American women have the highest rates, while Pacific Islander and Asian women have the lowest rates. In 2003, the rate for African American women was 17.8%, compared to 10.5% for Asian and Pacific Islander women and 11.5% for white women.
Notably, the rates for American Indian, white non-Hispanic, and Hispanic groups have been increasing since 2001. Babies born prematurely are at a greater risk of mortality and developmental problems. These complications can include the respiratory, immunologic, gastrointestinal, central nervous system, hearing, and vision systems, as well as longer-term problems with motor skills, vision, cognition, behavior, hearing, social-emotional development, health, and growth.
The impact of preterm birth can also have a significant financial and emotional impact on families. It can strain public-sector services such as health insurance, education, and social support systems. In 2005, the societal and economic burden associated with preterm birth in the US was at least $26.2 billion. While infants born at the earliest gestational ages are at the highest risk for mortality and morbidity, most preterm births occur closer to term and still experience more complications than full-term infants.
Labor involves three primary components: persistent uterine contractions, cervical changes and activation of the membranes and decidua. While labor at term occurs via a normal physiologic activity, preterm labor is pathological and can result from acute or chronic processes that occur weeks before the onset of labor. One of the key pathological events in preterm labor is fetal inflammatory response syndrome (FIRS), which triggers systemic inflammation and elevates fetal plasma interleukin-6 levels. FIRS is often triggered by chorioamnionitis.
It stimulates the release of corticotropin-releasing hormone by the fetal hypothalamus, leading to the secretion of adrenocorticotropic hormone (ACTH) and cortisol production by the fetal adrenal glands. This activates the parturition pathway and leads to the incursion of inflammatory cells into the cervical stroma, which releases cytokines and prostaglandins that stimulate cervical ripening. Cervical ripening involves changes in the collagen and glycosaminoglycan structures that make up cervical tissue.
Estrogen stimulates collagen degradation, while progesterone inhibits it. Consequently, progesterone is often used to prevent or delay cervical ripening. Both hormones are also implicated in regulating the formation of gap junctions and the upregulation of connexin 43 proteins, which contribute to parturition. Uterine contractions are also essential for labor, and the transition from uncoordinated to coordinated contractions is attributed to neural control.
Oxytocin plays a vital role in regulating the circadian rhythm of uterine contractions. The degradation of the extracellular matrix is assessed by detecting fetal fibronectin in cervicovaginal secretions, which is also a part of the parturition process. Detection of fetal fibronectin between 22 and 37 weeks of gestational age indicates the disruption of the decidual-chorionic interface and an increased risk of preterm labor.
Preterm birth, defined as delivery before 37 completed weeks of gestation, is a significant cause of neonatal morbidity and mortality worldwide. It is often associated with maternal medical conditions such as chronic hypertension, gestational diabetes mellitus, and systemic lupus erythematosus.
These conditions can alter placental function, resulting in fetal growth restriction and increasing the risk of preeclampsia, which can lead to indicated preterm birth. Other factors such as maternal underweight or obesity, a family history of preterm birth, and short interpregnancy intervals can also increase the risk of preterm birth. Assisted reproductive technologies, which often result in multiple gestations, are also associated with a higher risk of preterm delivery.
medtigo
Preterm Birth
Updated :
January 9, 2024
WHO defines preterm infants as babies born alive before the 37th week of pregnancy. Preterm birth is divided into subcategories depending on gestational age, early premature (less than 28 weeks) extremely premature (28 to 32 weeks). Mild to late preterm (32 to 37 weeks). Preterm birth is a multifaceted dilemma that involves various interrelated factors.
These include individual social, behavioral, and psychological factors, medical conditions, environmental exposures, fertility treatments, biological influences, and genetics. Often, these factors coincide, particularly in individuals who are economically disadvantaged or belong to ethnic and racial minority groups. Preterm labor refers to childbirth between 20 weeks and 36 weeks of gestation, with early preterm birth being defined as birth before 33 weeks and late preterm birth as birth between 34 and 36 weeks.
The rate of preterm births in the United States has been steadily increasing over the past decade. In 2004, 12.5% of births occurred before 37 completed weeks of gestation. Unfortunately, there are significant disparities in the rates of preterm birth based on race, ethnicity, and socioeconomic status. African American women have the highest rates, while Pacific Islander and Asian women have the lowest rates. In 2003, the rate for African American women was 17.8%, compared to 10.5% for Asian and Pacific Islander women and 11.5% for white women.
Notably, the rates for American Indian, white non-Hispanic, and Hispanic groups have been increasing since 2001. Babies born prematurely are at a greater risk of mortality and developmental problems. These complications can include the respiratory, immunologic, gastrointestinal, central nervous system, hearing, and vision systems, as well as longer-term problems with motor skills, vision, cognition, behavior, hearing, social-emotional development, health, and growth.
The impact of preterm birth can also have a significant financial and emotional impact on families. It can strain public-sector services such as health insurance, education, and social support systems. In 2005, the societal and economic burden associated with preterm birth in the US was at least $26.2 billion. While infants born at the earliest gestational ages are at the highest risk for mortality and morbidity, most preterm births occur closer to term and still experience more complications than full-term infants.
Labor involves three primary components: persistent uterine contractions, cervical changes and activation of the membranes and decidua. While labor at term occurs via a normal physiologic activity, preterm labor is pathological and can result from acute or chronic processes that occur weeks before the onset of labor. One of the key pathological events in preterm labor is fetal inflammatory response syndrome (FIRS), which triggers systemic inflammation and elevates fetal plasma interleukin-6 levels. FIRS is often triggered by chorioamnionitis.
It stimulates the release of corticotropin-releasing hormone by the fetal hypothalamus, leading to the secretion of adrenocorticotropic hormone (ACTH) and cortisol production by the fetal adrenal glands. This activates the parturition pathway and leads to the incursion of inflammatory cells into the cervical stroma, which releases cytokines and prostaglandins that stimulate cervical ripening. Cervical ripening involves changes in the collagen and glycosaminoglycan structures that make up cervical tissue.
Estrogen stimulates collagen degradation, while progesterone inhibits it. Consequently, progesterone is often used to prevent or delay cervical ripening. Both hormones are also implicated in regulating the formation of gap junctions and the upregulation of connexin 43 proteins, which contribute to parturition. Uterine contractions are also essential for labor, and the transition from uncoordinated to coordinated contractions is attributed to neural control.
Oxytocin plays a vital role in regulating the circadian rhythm of uterine contractions. The degradation of the extracellular matrix is assessed by detecting fetal fibronectin in cervicovaginal secretions, which is also a part of the parturition process. Detection of fetal fibronectin between 22 and 37 weeks of gestational age indicates the disruption of the decidual-chorionic interface and an increased risk of preterm labor.
Preterm birth, defined as delivery before 37 completed weeks of gestation, is a significant cause of neonatal morbidity and mortality worldwide. It is often associated with maternal medical conditions such as chronic hypertension, gestational diabetes mellitus, and systemic lupus erythematosus.
These conditions can alter placental function, resulting in fetal growth restriction and increasing the risk of preeclampsia, which can lead to indicated preterm birth. Other factors such as maternal underweight or obesity, a family history of preterm birth, and short interpregnancy intervals can also increase the risk of preterm birth. Assisted reproductive technologies, which often result in multiple gestations, are also associated with a higher risk of preterm delivery.
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