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Saturday, 14 December 2013

Preterm Labor in Pregnancy - The Treatments

Preterm labor is defined as a premature labor between 20 - 37 weeks of gestation before full term. According to the statistic, 1 in 8 babies is born premature and 12% of all pregnancies are ended in preterm pregnancy, causing life longed health problem to some and one of the leading cause of infant death.
The aim of most treatments have been directed toward the inhibition of myometrial contractions by delay delivery long enough to allow certain treatments and to transfer the mother and fetus to an appropriate hospital.
A. In general approaches
Treatment of preterm labor are depended totally in the types of symptoms of which a woman is experiencing. In many case, closely managing such as below are beneficial, depending to the diagnosis.
1. Empty your bladder

2. Lie down tilted towards your left side may slow down or stop signs and symptoms
3. Avoid lying flat on your back to prevent the increased uterine contractions to increase
4. Drink several glasses of water to reduce the risk of dehydration cause of contractions
5. Monitor the time of between contractions for one hour every day
6. Etc. Remember that premature labor does not always result in premature delivery. Some women experience the symptoms of premature labor, sometimes put on bed rest until the pregnancy progresses further.

B. Medication
B.1. Tocolytics
Tocolytics also known as
anti-contraction medications are the types of medication used to suppress premature labor for women who are experience the symptoms of preterm labor with an aims to buy time for the administration of certain medication to accelerate fetal lung maturity, including beta-mimetics (terbutaline), magnesium sulfate,
calcium channel blockers (for example, nifedipine), non-steroidal anti-inflammatory drugs, NSAIDs (indomethacin), etc..

B.2. Progesterone
Progesterone 17-hydroxyprogesterone caproate, can help to reduce the risk of preterm birth in women with recurrent preterm birth by 40–55%as it relaxes the uterine musculature, maintains cervical length, and has anti-inflammatory effect. In a study of " Polymorphisms in folate metabolizing genes and risk for spontaneous preterm and small-for-gestational age birth." by Engel SM, Olshan AF, Siega-Riz AM, Savitz DA, Chanock SJ., researchers concluded that our results suggest the possibility of a direct or indirect role for the SHMT1(1420)T variant in spontaneous preterm or SGA births.

B.3. Antibiotics and Preterm Labor, including Premature Rupture of Fetal Membranes
In case of preterm labor is a result of infection than antibiotic is given through IV injection. In a study of "Can antibiotics prevent preterm birth--the pro and con debate." by Lamont RF., researcher found that Antibiotics used prophylactically for the prevention of preterm birth are more likely to be successful if: they are used in women with abnormal genital tract flora (rather than other risk factors for preterm birth, e.g. low BMI, twins, generic previous preterm birth); they are used early in pregnancy prior to infection (tissue penetration/inflammation and tissue damage); they are used in women with the greatest degree of abnormal genital tract flora; and if they are used in women with a predisposition to mount a damaging inflammatory response to infection.

B.4. Cervical cerclage
In case of preterm labor is as a result of cervix shortens, cervical cerclage is benefial by placing a suture around the cervix that can prevent further shortening and widening. But cccording to the study of "Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data." by Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM., researchers found that Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.

B.5. Antenatal Corticosteroids
In order to prevent the damage as a result of immature lungs which are not yet producing their own surfactant of preterm baby, medcation of Antenatal Corticosteroids such as Betamethasone, dexamethasone, etc., is beneficial to stimulate the production of surfactant in the lungs of the fetus.
B.6. Etc.
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