Preterm Labor

Definition
• Adanya persalinan yang dimulai sblm 37 mgg
-> Adanya kontraksi disertai perubahan serviks -
> dpt berlanjut menjadi kelahiran preterm
• Susceptible to various serious medical
complication during the newborn period as
well as morbidities extending later in life ->
consequence of immature organs that result
from abbreviated gestation
 Tanda dan Gejala
• Adanya kontraksi/kram perut
• Keluar flek, darah, atau cairan pervaginam
• Gejala2 infeksi
• Gejala2 preeklampsia
 RDS
• Most common -> RDS -> caused by immature
lungs that are unable to sustain necessary
oxygenation
• Clinical -> tachypnea, chest wall retracts,
expiration accompanied by grunting and
nostril flaring, poor eripheral circulation and
systemic hypotension
• Radiograph-> air bronchogram
• Therapy -> surfactant prophylaxis & antenatal
corticosteroid
 Necrotizing Enterocolitis
• ->the wall of intestine is invaded by bacteria,
which cause local infection and inflammation
that can ultimately destroy the wall of the
bowel instestine
• Clinical findings: bowel distention, ileus,
bloody stool
• Radiograph: pneumatosis intestinalis -> bowel
wall gas derived from invading bacteria
• Treatment still controversial
 Retinopathy of prematurity
• Largest single cause of blindness in US
• The fetal retina vasularizes centrifugally from the optic
nerve starting at approximately the fourth month and
continues shortly after birth. During vasularization,
excessive oxygen induces severe retinal
vasoconstriction with endothelial damage and vessel
obliteration, especially in temporal portion.
Neovascularization results, and the new vessels
penetrate the retina and extend into the vitreous. Here
they are prone to leak proteins or burst with
subsequent hemorrhage. Adhesions then form, which
detach retina.
 Brain disorders
• Central nervous system injury in preterm ->
different neuroanatomical sequelae
• Neuroimaging -> intraventricular hemorrhage,
periventricular hemorrhagic infarction, cystic
periventricular leukomalacia, diffuse white
matter injury -> adverse neurodevelopmental
outcome
• Detect using-> cranial sonography
 Cerebral palsy
• A group of conditions that are characterized
by chronic movement or posture
abnormalities that are cerebral in origin, arise
early in life, and are nonprogressive.
• Major types: spastic quadriplegia, diplegia,
hemiplegia, choreoathetoid types, mixed
varieties
 Therapy
• Cegah persalinan preterm
• Obati pencetus
• Tirah baring dan hidrasi
• Pematangan paru
• Antibiotik
• Pilihan moda pesalinan
• Persiapan perawatan bayi BBLR
1. Tokolisis = menghambat kontraksi myometrium
-Terbutalin
-Nifedipin
-MgSO4
-Indometacin

KI tokolisis:
IUFD/kelainan kongenital lethal
PJT berat, IIU, perdarahan hebat
PEB dan eklampsia
2. Sirklase
Jahitan pada serviks sebagai terapi pilihan untuk
pencegahan kelahiran prematur pada wanita
dengan insufisiensi/inkompetensi serviks.
Teknik: Mcdonalds dan modifikasi shirodkar
3. Pematangan paru
Kortikosteroid -> mencegah terjadinya RDS
Diberikan pada usia kehamilan <34mg
Hasil terlihat stlh 18 jam dosis pertama, hasil
maksimal stlh 48 jam
4. Terapi antibiotik

Penting krn chorioamnionitis merupakan penyebab

tersering dari persalinan preterm

Agen infeksi tersering: BV, strep B, hemoliticus

group B, E coli

Ab pilihan: clindamisis, erithromisin, vancomisin,

sesuai hasil kultur
 Persalinan
• Persalinan dpt diteruskan jika:
Usia kehamilan > 37 mgg
Pembukaan serviks >3cm
Terdapat perdarahan aktif
Gawat janin, IUFD, atau terdapat kelainan
kongenital berat
Terdapat amnionitis atau preeklampsia