Download premature rupture of membrane

Premature Delivery
Premature Rupture of Membrane
Prolonged Pregnancy, Multiple Pregnancy
Women Hospital , School of Medical,
ZheJiang University
Yang Xiao Fu
Preterm labour
Preterm labour



Defined as delivery after gestation 28 completed
weeks till 37 weeks (196-258 days). Birth
weight 1000g - 2449g
Preterm labour makes up 5% - 15% of total
number of delivery
Can the lower limit of preterm labour be brought
earlier to 20 weeks gestation?
Diagnosis of preterm labour




Labour occurring between gestation 28
completed weeks and 37 weeks
regular uterine contraction:≥ 4 times in
20 minutes or 8 times in 60 minutes
cervical shortening of ≥ 75%
progressive cervical dilatation of 2cm and
above
Prediction of preterm labour

Ultrasound 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 <3cm,
indicating high possibility of preterm labour
Prediction of preterm labour

Fetal 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 membrane



Membrane rupture occurring before labour, known
as premature rupture of membrane (PROM)
Occurring after 37 completed weeks gestation, is
called premature rupture of membrane at term
Occurring before 37 weeks gestation, called
preterm premature rupture of membrane
(PPROM)
Effect to mother and fetus





Feto-maternal infection
Placenta abruptio
Premature infant: 30% - 40% of premature labour
is associated with premature rupture of membrane
Cord prolapse, cord compression
Poor fetal lung development and fetal compression
syndrome
Post-term pregnancy
Prolonged pregnancy
Prolonged pregnancy


Gestation at or beyond 42 weeks gestation
(>=294 days), known as post-term pregnancy
Important factor for fetal distress, meconium
aspiration syndrome, maturation disturbance
syndrome, newborn asphysia, perinatal death,
macrosomia and dystocia
Diagnosis






Determine gestational age
Calculation based on last menstrual period
Calculation based on ovulation
Ultrasound examination to ascertain gestation age
Period of manifestation of early pregnancy
symptoms, quickening
First trimester pelvic examination assessing uterine
size
Diagnosis






Assess placental function
Fetal movement count
Fetal electronic monitoring
Fetal biophysical profile (Ultrasound)
Urine E/C <10 or 24 hours urine E3 <10mg
amnioscopy
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 labour
Caesarean section
Neonatal resuscitation
Multiple pregnancy
Multiple pregnancy


Conception 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 twin



Dizygotic twin makes up 70% of twin
pregnancy
Associated with ovulation induction, multiembryo intrauterine transplantation and
genetic factors
Two separate ova being fertilized forming
two zygotes, each genetic compositions is not
identical, hence the differences in both
fetuses
Dizygotic twin


The placentas are usually dichorionic, can
be fused together, but each has own
independent blood circulation
Two amniotic cavities are seen at the fetal
surface of placenta, two layers of amniotic
membrane and two layer of chorionic
membrane present within
Monozygotic twin




Monozygotic twin makes up approximately 30% of
twin pregnancy
Unclear cause, higher incidence in older pregnant
women
Single fertilized ovum differentiating into two
fetuses, thus gender, blood type and other
phenotypes are identical
As the fertilized ovum differentiates at different
times, forming 4 types
Diamniotic dichorionic
monozygotic twin




Differentiate within 72 hours of fertilization
Form two independent fertilized ova and two
amniotic sac, two layers of chorionic membranes
and two layers amniotic membranes within the
amniotic sacs
Maybe single or two placentas
Makes up approximately 30% of monozygotic
twins
Diamniotic monochorionic
monozygotic twin




Differentiation occurs from 72 hours to 8 days of
fertilization
One layer of chorionic membranes and Two layers
of amniotic membranes within two amniotic sacs
Single placenta
Makes up 68% of monozygotic twins
Monoamniotic monochorionic
monozygotic twin




Differentiation within 9-13 days after
fertilization
Both fetuses share a single amniotic cavity
Single placenta
Makes up 1% - 2% of monozygotic twins
Conjoined twin


Differentiation 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 twins
Incidence is 1/1500 of monozygotic twins
Conjoined twin
