Persalinan Preterm

Etiologi
Maternal-fetal stress
As discussed earlier, the last trimester is marked by rising maternal
serum levels of placental-derived corticotropin-releasing hormone
(CRH). This hormone works with adrenocorticotropic hormone
(ACTH) to increase adult and fetal adrenal steroid hormone
production, including the initiation of fetal cortisol biosynthesis.
Rising levels of maternal and fetal cortisol further increase placental
CRH secretion, which develops a feed-forward endocrine cascade
that does not end until delivery (Fig. 21-17, p. 425). Rising levels of
CRH further stimulate fetal adrenal dehydroepiandrosterone sulfate
(DHEA-S) biosynthesis, which acts as substrate to increase maternal
plasma estrogens, particularly estriol.

 Uterine Distention
There is no doubt that multifetal pregnancy and hydramnios
lead to an increased risk of preterm birth. It is likely that
early uterine distention acts to initiate expression of
contraction-associated proteins (CAPs) in the myometrium.
The CAP genes that are influenced by stretch include those
coding for gap-junction proteins such as connexin 43, for
oxytocin receptors, and for prostaglandin synthase. Recent
reports suggest that gastrin-releasing peptides (GRPs) are
increased with stretch to promote myometrial contractility
and that GRP antagonists can inhibit uterine contractility

 Infections
Preterm Premature Rupture of Membranes
Multifetal Gestation

Panjang Serviks
Length Vaginal-probe sonographic cervical assessment has been evaluated extensively
during the past two decades. When performed by trained operators, cervical length
analysis using transvaginal sonography is safe, highly reproducible, and more predictive
than transabdominal sonographic screening (American College of Obstetricians and
Gynecologists, 2012b). Unlike the transabdominal approach, transvaginal cervical
sonography is not affected by maternal obesity, cervix position, or shadowing from the
fetal presenting part. Technique is important, and Yost and colleagues (1999) have
cautioned that special expertise is needed. Iams and coworkers (1996) measured cervical
length at approximately 24 weeks gestation and again at 28weeks in 2915 women not at
risk for preterm birth. The mean cervical length at 24 weeks was approximately 35 mm,
and those women with progressively shorter cervices experienced increased rates of
preterm birth.
Until recently, routine cervical length evaluation in women at low risk was not advocated
because, like other factors associated with potentially higher preterm birth risk, no
effective treatments were available. Randomized trials done to investigate vaginal
progesterone use in women with short cervix diagnosed during screening have stimulated
consideration of whether or not such screening is warranted (Fonseca, 2007; Hassan, 2011)

Tokolisis
Ca channel blocker
Inhibitor prostaglandin
Oxytocin receptor inhibitor
MgSO4
Nitrate
Betamimetic

Golongan

Cara Kerja

Benefit

Efek Samping

Jenis Obat

Ca Ch Blocker

Blocking
transmembrane
calcium
transport
Reduce intracellular calcium

- Per oral
- Low cost
- Minimum side
effects

Constipation,
diarrhea,
dizziness or
lightheadedness,
Flushing,
headache,
nausea.
- Uncommon:
vasodilation,
drug induced
hepatitis, fluid
retention,
hypocalcaemia,
hypoglycaemia,
hypotension,
tachycardia,
altered
uteroplacental
blood flow

Nifedipine
- Initial dose
20mg
- Followed by 3
doses: 20mg
every 30
minutes if
contractions
continue
- Maintenance
dose: 2040mg orally
four hourly for
48 hours
- Max dose
160mg/24
hours)
- Caution with
doses > 60mg
- After 72
hours, if
maintenance

Pematangan Paru Janin

Resiko paru belum matang pada janin:
< 28 minggu: 60-80%
32-36 minggu: 15-30%
36-37 minggu: 5%

Penanganan KPD

Konservatif

Usia Kehamilan

Tanda Inpartu

Infeksi

Penatalaksanaan

< 32 minggu

Rawat sampai ar
ketuban tidak keluar
lagi

32-37 minggu

Berikan
dexametason,
terminasi pada
kehamilan 37
minggu

Berikan tokolitik,
dexametason,
terminasi sesudah
24 jam

+/+
Berikan antibiotic
Aktif
dan lakukan induksi
Kehamilan > 37 minggu, induksi dengan menggunakan oksitosin atau misoprostol
(observasi tandatanda infeksi)