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1、預防早產新觀念Preventionofpretermparturition2014.04.26高雄長庚婦產部產科主任蔡慶璋IntroductionPretermbirthreferstoadeliverythatoccursbefore370/7thsweeksofgestation12%ofbirthsinUSA20%ofpretermdeliveriesareiatrogenic;performedduetomedicalorobstetricalcomplicationsthatarebelievedtoputthehealthofthemo
2、therorfetusinjeopardy(eg,intrauterinegrowthrestriction,preeclampsia,placentaprevia,nonreassuringantenatalfetaltesting).80%pretermdeliveriesarespontaneous,relatedtopretermlabororpretermprematureruptureofthemembranes.Classification —SubtypesofpretermbirthBygestationalage:Moderat
3、epreterm:32to<37weeksLatepreterm:340/7thsto366/7thsweeksVerypreterm:28to<32weeksExtremelypreterm:<28weeksBybirthweight:Lowbirthweight(LBW):<2500gramsVerylowbirthweight(VLBW):<1500gramsExtremelylowbirthweight(ELBW):<1000gramsPathogenesisofspontaneouspretermbirthActivationofthem
4、aternalorfetalhypothalamic-pituitary-adrenalaxisassociatedwitheithermaternalanxietyanddepressionorfetalstressInfection:Someorganismseg,Pseudomonas,Staphylococcus,Streptococcus,Bacteroides,andEnterobacter)produceproteases,collagenases,andelastasesthatcandegradethefetalmembranes
5、.BacteriaalsoproducephospholipaseA2(whichleadstoprostaglandinsynthesis)andendotoxin,substancesthatstimulateuterinecontractionsandcancausePTLDecidualhemorrhage:damageddecidualbloodvesselsandpresentsclinicallyasvaginalbleedingorretroplacentalhematomaformationPathologicaluterined
6、istentionMultiplegestation,polyhydramnios,PathologiccervicalchangeCervicalinsufficiencySignificance—Pretermbirththeleadingdirectcauseofneonataldeath(deathinthefirst28daysoflife).Itisresponsiblefor27%ofneonataldeathsworldwideTheriskofneonatalmortalitydecreasesasgestationalageat
7、birthincreases(figure)Theburdenofpretermbirthincludesneonatalmorbidityandlong-termsequelae,includingneurodevelopmentaldeficits(eg,cerebralpalsy,impairedlearning,visualdisorders)andanincreasedriskofaspectrumofdiseasesinadulthoodInaddition,pretermbirthisthesecondmostcommoncauseo
8、f-death(afterpneumonia)inchildrenyoungerthan5yearsUNPROVENINT
