4/20/2016

Preterm
PRETERM BIRTH Prematurity
Low birth weight

American Academy of Pediatrics (1935)

live born infant 2500 gr
ACOG (1995)
Preterm birth < 37 weeks
Low birth weight : infants who are born to
small
Preterm/premature birth : infants who are
born to soon
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Definition
World Health Organization (WHO, 1993) :
Preterm : gestasional age of less than 37
completed weeks (259 days) from the first day of
the last menstrual period
Very premature fetus ( delivery at 24 29.9
weeks)
Moderately premature fetuses ( delivery at
30 36.9 weeks)
SIZE
Normally grown (appropriate for gestational
age)
Small for gestational age (< 10th percentile)
Large for gestational age ( > 90th percentile)
Intrauterine growth restriction
Preterm could be small or large for gestational age
Some preterm also suffered growth restriction in utero

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BIRTH WEIGHT (WHO) CURRENT DEFINITIONS

Low birth weight < 2500 g
Very low birthweight < 1500 g
Extremely low birthweight < 1000 g
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Birth weight
Low birth weight (LBW) < 2500 g
Very Low birth weigh (VLBW) < 1500 g
Gestation lenght
Premature (preterm delivery, PTD) < 37 weeks
Early pretem delivery < 32 weeks
Growth restriction
< 10th percentile for gestational age
IUGR : intrauterine growth restriction applies to
fetuses
SGA : small for gestational age applies to neonate
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Pathways to preterm birth

Inflammation
Infection : 40%
Activation of the maternal-fetal-
hypothalamic-pituitary-adrenal (HPA) axis
Stress : 30%
Decidual hemorrhage
Abruption : 20%
Uterine distention
Stretching : 10% Stratifikasi risiko dan mekanisme patologis pada persalinan premature. (Lockwood CJ dan Kuczynski, 2001)

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Three main condition explain preterm

birth
Infection
Sexually transmitted infections
Medically indicated (iatrogenic) : Bacterial vaginosis
25% Genitoury infections
Asymptomatic bacteriuria
Pyelonephritis
Preterm premature rupture of
membranse (PPROM) : 25% Pneumonia
Peritonitis
Periodontal disease
Spontaneous (idiopathic) : 50% Stress and lifestyle

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PROBLEMS COMPLICATION
Perinatal mortality Respiratory distress syndrome
Serious neonatal morbidity Bleeding in the brain : intraventricular
Moderate to severe childhood disability hemorrhage (IVH)
Patent ductus arteriosus
Necrotizing enterocolitis (NEC)
Retinopathy of prematurity (ROP)

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DIAGNOSIS
Sign & symptoms Bacterial vaginosis (BV)
Painful uterine contraction Lactobacillus vaginalis replaced with anaerobic
Progressive dilatation and effacement of the bacteria
cervix
Gardnerella vaginalis, Mobiluncus species,
USG mycoplasma hominis
Cervical lenght
Fetal fibronectin
Intracellular adhesion
Stromal remodelling of the cervix prior labor

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MANAGEMENT Obat tokolitik

Tocolytic OBAT DOSIS AWAL DOSIS
LANJUTAN
EFEK SAMPING

Tarbutaline Salbutamol 10 gram dalam dinaikkan 10 Takikardi, edema

Magnesium sulfate NaCl atau RL, 10 tetes/30 menit paru
tetes sampai kontraksi
Indomethacin hilang atau nadi
Nifedipine ibu > 120 mg

Corticosteroids : < 34 weeks , to promote fetal MgSO4 6 gram 2 gram/jam Hipermagnesia,

kontrol
lung maturation pernapasan &
Dexametason 5 mg/im/6 jam :4 dosis refleks tendo
Nifedipin 20 mg PO 3 x 20 mg PO Lemas, hipotensi
Betametason 12 mg/im/12 jam : 2 dosis
Nitrat 10 mg sublingual dilanjutkan Pusing, sakit ke-
dengan 20 mg PO ala, mual
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Keputusan untuk merujuk PREVENTION

Tersedianya sarana neonatus atau obstetrik yang baik
Tersedianya transportasi dan tenaga yang ahli Identification of risk factors
Waktu perjalanan Adequate rest
Resiko terhadap kesejahteraan ibu dan janin Nutritional supplement
Resiko persalinan dalam perjalanan Avoidance smoking
Paritas dan lama persalinan sebelumnya Circlage operation
Kondisi servik
Progesterone
Kontraksi
Respon terhadap tokolisis High risk women

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Kesimpulan
Diagnosis awal yang akurat
Identifikasi dan obati penyebab bila mungkin
Coba untuk mempertahankan kehamilan bila
memungkinkan
Tindakan untuk meminimalkan mortalitas dan
morbiditas neonatus
terapi steroid antenatal
merujuk pasien
optimalkan sarana yang ada bila tidak memungkinkan
untuk dirujuk

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