Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy

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Premature Delivery Premature Rupture of
MembraneProlonged Pregnancy, Multiple Pregnancy

• Women Hospital , School of Medical, ZheJiang
  University
• Yang Xiao Fu

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Preterm labour
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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?

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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

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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 lt3cm, indicating high
  possibility of preterm labour

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Prediction of preterm labour

• Fetal fibronectine (fFN), after 20 weeks
  gestation fFNgt50ng/ml, indicates possibility of
  preterm labour. Its sensitivity is up to 93,
  specificity 82

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Premature rupture of membrane
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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)

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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

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Post-term pregnancy

• Prolonged pregnancy

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Prolonged pregnancy

• Gestation at or beyond 42 weeks gestation (gt294
  days), known as post-term pregnancy
• Important factor for fetal distress, meconium
  aspiration syndrome, maturation disturbance
  syndrome, newborn asphysia, perinatal death,
  macrosomia and dystocia

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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

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Diagnosis

• Assess placental function
• Fetal movement count
• Fetal electronic monitoring
• Fetal biophysical profile (Ultrasound)
• Urine E/C lt10 or 24 hours urine E3 lt10mg
• amnioscopy

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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

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Multiple pregnancy
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Multiple pregnancy

• Conception of 2 or more fetuses in the same
  intra-uterine pregnancy
• Incidence of multiple pregnancy 180n-1
• (n represents number of fetus in a single
  pregnancy)

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Dizygotic twin

• Dizygotic twin makes up 70 of twin pregnancy
• Associated with ovulation induction, multi-embryo
  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

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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

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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

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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

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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

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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

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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

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Conjoined twin
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