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1、PretermLabor早产LinJianhuaM.D.,Ph.D.,ProfessorDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicineepidemiologyLaboranddeliverybetween28–36+6weeks5%-10%betheleadingcauseofperinatalmorbidityandmortalitySurvivalrateshaveincreasedandmorbidityha

2、sdecreasedbecauseoftechnologicadvancesRiskFactorsPreviouspretermdelivery•Lowsocioeconomicstatus••Maternalage<18yearsor>40years•Pretermprematureruptureofthemembranes•Multiplegestation•Maternalhistoryofoneormorespontaneoussecond-trimesterabortions•Maternalcomplicati

3、ons(medicalorobstetric)--Lackofprenatalcare•UterinecausesMyomata(particularlysubmucosalorsubplacental)UterineseptumBicornuateuterusCervicalincompetence•Abnormalplacentation•InfectiouscausesChorioamnionitisBacterialvaginosisAsymptomaticbacteriuriaAcutepyelonephriti

4、sCervical/vaginalcolonization•FetalcausesIntrauterinefetaldeathIntrauterinegrowthretardationCongenitalanomaliesdiagnosiscervicaleffacementand/ordilatationincreaseduterineirritabilitybefore37weeksofgestationforecast:uterineactivitymonitoring.UltrasoundExaminationof

5、CervicallengthFetalFibronectintreatmentBedRestTocolysisCorticosteroidTherapyAntibioticTherapyAlthoughbedrestisoftenprescribedforwomenathighriskforpretermlaboranddelivery,therearenoconclusivestudiesdocumentingitsbenefit.Arecentmeta-analysisfoundnobenefittobedrestin

6、thepreventionofpretermlaborordelivery.Tocolytictherapymayoffersomeshort-termbenefitinthemanagementofpretermlabor.Adelayindeliverycanbeusedtoadministercorticosteroidstoenhancepulmonarymaturityandreducetheseverityoffetalrespiratorydistresssyndrome,alsobeusedtofacili

7、tatetransferofthepatienttoatertiarycarecenterNostudyhasconvincinglydemonstratedanimprovementinsurvival,long-termperinatalmorbidityormortality,orneonataloutcomewiththeuseoftocolytictherapyalone.TocolyticTherapyMagnesiumsulfate(Intracellularcalciumantagonism)Terbuta

8、line(Bricanyl)Beta2-adrenergicreceptoragonistsympathomimetic;decreasesfreeintracellularcalciumionsRitodrine(Yutopar)SameasterbutalineNifedipine(Procardi