Therapeutic target The goal is either to prolong (extend) the pregnancy as far as possible in time, since the daily increase in maturity means a reduction in morbidity (disease incidence) and mortality (death rate), or, in the case of appropriate pathology such as marked placental insufficiency, induce lung maturity by administration of glucocorticoids and transfer … Impending Premature Birth: Drug Therapy
Obligatory medical device diagnostics. Vaginal sonography (ultrasound using an ultrasound probe inserted into the vagina)) – measurement of cervical length (length of cervix); indications: From the 16th week of gestation, if there is a history of spontaneous preterm birth. Symptomatic patients [Pregnant women with a history of preterm birth and cervical shortening < 25 mm … Impending Premature Birth: Diagnostic Tests
1st order. Surgical therapy is controversial from both prophylactic and therapeutic points of view, as the benefit has not yet been proven beyond doubt. Operative options include: Cerclage (cervical wrap, surgical method to keep a prematurely opening cervix still closed); indication: Women with singleton pregnancy after previous spontaneous preterm delivery or late abortion whose vaginal … Impending Premature Birth: Surgical Therapy
To prevent threatened preterm birth, attention must be paid to reducing risk factors. These measures, which are started before or during pregnancy and are effective, are called primary prevention in contrast to secondary prevention, which involves prophylactic therapeutic measures after an increased risk has been identified during prenatal care. Primary prevention Behavioral risk factors Diet … Impending Premature Birth: Prevention
The following symptoms and complaints may indicate impending preterm birth: Leading symptoms Premature labor Premature rupture of membranes* Cervical insufficiency (weakness of the cervix) Associated symptoms Preterm labor/cervical insufficiency Pulling in the abdomen Pulling in the back Hardness of the abdomen Bleeding Premature rupture of the bladder/amniotic infection syndrome (AIS; infection of the membranes, egg … Impending Premature Birth: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Threatened preterm birth. or premature birth, is the result and final course of many different underlying pathologies (abnormal and pathological processes and conditions in the body). The most important causes are infections and disorders of placental (placental) function due to decreased uteroplacental (uterine and placental) blood flow. The manner in which … Impending Premature Birth: Causes
General measures Bed rest. Although it is not established that bed rest leads to a reduction in the rate of preterm birth, premature labor, and an increased propensity to contract, according to general clinical experience, the complete cessation of physical activity, if possible, is part of the additive therapeutic principle. According to the current S2k … Impending Premature Birth: Therapy
The following are the most important conditions or complications that may be contributed to by preterm birth: Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Patent ductus arteriosus (synonyms: Called ductus arteriosus botalli, ductus botalli, or ductus arteriosus Harvey; provides a connection between the aorta (the aorta) and truncus pulmonalis (pulmonary artery) in the fetal (prenatal) … Impending Premature Birth: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing). Skin and mucous membranes Abdominal wall and inguinal region (groin area). Auscultation (listening) of the heart. Auscultation of the lungs Gynecological-obstetrical examination. Inspection Vulva (external, primary … Impending Premature Birth: Examination
1st order laboratory parameters – obligatory laboratory tests. Determination of the vaginal pH Microbiological smear collection for clarification of infections. Urinalysis – to rule out possible cystitis (urinary bladder infection). A rapid test for nitrite detects nitrite-forming bacteria in the urine, if necessary. [Nitrate detection in urinary tract infection (UTI): 95% with positive nitrate test … Impending Premature Birth: Lab Test
The medical history (history of illness) represents an important component in the review of potential risk and thus in the diagnosis of threatened preterm birth. Social history Age <18 years, >30 years Single mother Physical stress Low social status Vegetative anamnesis including nutritional anamnesis. Smoking Alcohol Other drugs Self-history Pre-existing conditions, e.g.: Diabetes mellitus Hypertension … Impending Preterm Birth: Medical History
Certain conditions originating in the perinatal period (P00-P96). Harm to the fetus or newborn caused by: Cervical insufficiency (weakness of the cervix). Premature rupture of membranes (PROM). Other and unspecified morphological and functional placental abnormalities (abnormalities of the placenta), including: Placental dysfunction (-malfunction), -infarction (tissue death due to hypoxia), -insufficiency (-weakness). Pregnancy, childbirth and puerperium … Impending Preterm Birth: Or something else? Differential Diagnosis