1. Women Hospital , School of Medical, ZheJiang University Yang Xiao Fu
Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy
Women Hospital , School of Medical, ZheJiang University
Yang Xiao Fu

2. Preterm labour

3. Preterm labour
Defined as delivery after gestation 28 completed weeks till 37 weeks ( days). Birth weight 1000g g
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?

4. Classification Spontaneous preterm labor
Preterm prematurely ruptured membranes
Preterm birth for medical and obstetrical indications

5. 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 ≥ 80%
progressive cervical dilatation of 1cm and above

6. 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 <2.5cm, indicating high possibility of preterm labour

8. 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%

9. Treatment Bed rest Corticosteroids Tocolysis Antibiotics
Conduct of labor ＆ delivery

10. Treatment Tocolysis ß-adrenergic receptor agonists magnesium sulfate
atosiban
calcium-channel blockers
prostaglandin inhibitors

11. Premature rupture of membrane

12. 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)

13. Etiology Maternal infection Hydramnios Cervical incompetency
Nutritional deficit
Others

14. Clinical Findings and Diagnosis
Sudden gush of fluid or continued leakage
Amniotic fluid in the posterior fornix
Nitrazine test
Ferning
fFN
IGFBP-1
Amniotic fluid testing
Ultrasound

15. 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

16. Treatment Term pregnancy without amnionitis expectment management
labor induction

17. Treatment Preterm pregnancy without amnionitis expectment management
best rest
antibiotics
tocolysis
corticosteroids
termination of pregnancy

18. Post-term pregnancy
Prolonged pregnancy

19. 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

20. 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

21. 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

22. 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
Cervical ripening
Induced labour
Caesarean section
Neonatal resuscitation

23. Multiple pregnancy

24. 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)

25. 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

26. 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

27. 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

28. 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

30. 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

32. 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

33. 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

34. Conjoined twin

37. THANKS