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    RTCOG Clinical Practice Guideline

    The Management of Preterm Labour and

    Preterm Premature Rupture of Membranes

    OB014 ..2556-2558 ..2556-2558 20..2558

    (1-3)

    (Pretermbirth) 240/7*366/7

    (Pretermlabour) / 240/7*366/7

  • 16 |

    latepretermlabour 340/7-366/7

    (Pretermprematureruptureof membranes)

    240/7*366/7

    Lowbirthweight1,500 2,500

    Verylowbirthweight1,000 1,500

    Extremelylowbirthweight 5001,000

    *Thresholdofviability

    240/7500

    (3)

    240/7

    (500

    )366/7

    1. 420860

    2. 1

    3. 80

  • | 17

    (Predictionof

    pretermlabour)(3-8)

    1

    1

    (Preventionofpreterm

    labour)(3-9)

    2

  • 18 |

    2

    (3,10-15)

    .

    1.

    2.

    3.

    4.

    5. Doptonecardiotocography(CTG)

  • | 19

    6.

    6.1

    (Ano-vaginalswabculture)

    6.2

    6.3 completebloodcount(CBC)

    6.4

    6.5

    7.

    8.

    9.

    (in-utero

    transfer)

    . 34*

    34

    respiratorydistresssyndrome(RDS),necrotizingentero-

    colitis(NEC)intraventricularhemorrhage(IVH)

    9()

  • 20 |

    1.

    2.

    3.

    cardiotocography

    4.

    5.

    6. GroupBStreptococci

    (GBS)

    7.

    8.

    9. partogram

    10.

    2,000

    Piper

    forceps

    2,000

  • | 21

    11.

    11.1

    11.2

    *

    2,500

    . 34

    9()

    1.

    2.

    3.

    cardiotocography

    4.

    5.

    6.

  • 22 |

    6.1

    6.1.1

    6.1.2

    /

    6.1.3

    electrolytes,bloodsugar,BUN,Cr

    6.1.4

    6.2

    6.2.1

    6.2.2

    6.2.3

    6.2.4

    6.2.5

  • | 23

    6.2.6(Non-reassuring

    fetalstatus)

    (intrauterineresuscitation)

    6.2.7

    6.3

    24

    7. (Singlecourse)

    8.

    9. GroupBStreptococci

    (GBS)

    10.

    2,000

    Piperforceps

    2,000

  • 24 |

    11.

    11.1

    11.2

    (Pretermprematurerupture

    ofmembranes;PPROM)(3,14)

    (Pretermpremature

    ruptureofmembranes;PPROM)

    1.

    sterilespeculum

    2.

    3.

    4.

    34

    12

    34expectant

    2,500

  • | 25

    5.

    6.

    Doptonecardiotocography

    7.

    7.1 (ano-

    vaginalswabculture)

    7.2

    7.3 completebloodcount(CBC)

    7.4

    7.5

    8.

    8.1

    GroupBStreptococci(GBS)

    8.2 expectant

    (prolongedlatencyperiod)

    8.3 chorioamnionitis

    broadspectrum

  • 26 |

    9. 24-33expectant

    CBC

    chorioamnionitis,non-reassuring

    fetaltesting,placentalabruption,advancedlabour

    34

    10. 34-37

    2,500

    11.

    12.

    (in-uterotransfer)

    13.

    13.1

    13.2

    72

    13.3chorioamnionitis

    13.42

    13.5

  • | 27

  • 28 |

    (PPROM)

  • | 29

    (singlecourse)

    GBS

    in-uterotransfer

    neonataltransfer

  • 30 |

    1. RequejoJH,MerialdiM.Theglobalimpactofpretermbirth.In:

    BerghellaV,editor.Pretermbirth.Oxford,UK:Wiley-Blackwell;

    2010.p.1-7.

    2. WalshMC,FanaroffAA.Epidemiologyandperionatalservices.

    In:MartinRJ,FanaroffAA,WalshMC,editors.Neonatalperinatal

    medicine.9thed.Missouri:Elsevier;2011.p.19-23.

    3. Pretermlabour.In:CunninghamFG,LevenoKJ,BloomSL,Spong

    CY,DasheJS,HoffmanBL,etal.,editors.WilliamsObstetrics.

    24thed.NewYork:McGrawHill;2014.p.829-96.

    4. MercerBM,GolddenbergRL,DasA,MoawadAH,IamsJD,Meis

    PJ.Thepretermpredictionstudy:aclinicalriskassessment

    system.AmJObstetGynecol1996;174:1885-95.

    5. BerghellaV.Thecervix.In:BerghellaV,editor.Pretermbirth.

    Oxford,UK:Wiley-Blackwell;2010.p.50-7.

    6. RafaelTJ.Shortcervicallength.In:BerghellaV,editor.Preterm

    birth.Oxford,UK:Willey-Blackwell;2010.p.130-48.

    7. BisulliM.Fetalfibronectin.In:berghellaV,editor.Pretermbirth.

    Oxford,UK:Willey-Blackwell;2010.p.149-60.

    8. NessA,BlumenfieldY,SungJF.Pretermlabour.In:Berghella

    V,editor.Pretermbirth.Oxford,UK:Willey-Blackwell;2010.

    p.198-216.

    9. ACOGCommitteeOpinion.Useofprogesteronetoreduce

    pretermbirth.ObstetGynecol2003;102:1115-6.

  • | 31

    10. MercerBM.Prematureruptureofthemembranes.In:Berghella

    V,editor.Pretermbirth.Oxford,UK:Willey-Blackwell;2010.

    p.217-31.

    11. ACOGpracticebulletinNo.120:Useofprophylacticantibiotics

    inlaboranddelivery.ObstetGynecol2011;117(6):1472-83.

    12. ACOGpracticebulletinNo.127:Managementofpretermlabor.

    ObstetGynecol2012;119(6):1308-17.

    13. ACOGpracticebulletinNo.142:Cerclageforthemanagement

    ofcervicalinsufficiency.ObstetGynecol2014;123:372-9.

    14. FlenadyV,WojcieszekAM,PapatsonisDN,StockOM,Murray

    L,JardineLA,etal.Calciumchannelblockersforinhibiting

    pretermlabourandbirth.CochraneDatabaseSystRev2014;6.

    15. BhuttaZA,GiulianiF,HaroonA,KnightHE,AlbernazE,BatraM,

    etal.Standardisationofneonatalclinicalpractice.BJOG2013;

    120:56-63.

  • 32 |

    PretermlaborPretermpremature

    ruptureofmembranes

    A. (Tocolysis)

    viable336/7

    firstline3

    1. calciumchannelblockersnifedipine(Adalat)(1)

    1020

    ( )

    20

    203030 2

    maintenancedose20-406 160/24 corticosteroid

    160/24

    Transienthypotension Transienttachycardia Flushing Headache,dizziness Nausea Transientfetalhypoxiamaternalhypotension

    1 4 systolicBP100/min,BT>37.5C

  • | 33

    2. beta-adrenergicreceptoragonist terbutalinepretermlaborinjectableform48-72oralterbutaline(USFDA2011)2

    2.1 (2)

    electronic fetalmonitoringreactiveFHR1 648

    Tachycardia Hyperglycemia Metabolicacidosis Hypoxia Cardiogenicshockwithpulmonaryedema

    Terbutaline(Bricanyl)ampule(0.5/ 500/)

    Continuousintravenousinfusion controlledinfusion

    2.5-5/Bricanyl4 22,0005%D/W0.9% NSS1007-15microdrops/min

    2.5-5/(7-15microdrops/min)30 20-3025/ (75microdrops/min)

  • 34 |

    maintain 6 2.5-5/(7-15microdrops/min) corticosteroid 48-72 FDA 48-72

    > 140/ >180/

    Tremor,anxiety,nervousness,sweating Palpitation,arrhythmia,tachycardia Headache Myocardialischemia Dyspnea,pulmonaryedema Musclecramp,hypokalemia Hyperglycemia

    4 fluidintake/output,urineoutput glucosepotassium4-6 electronic fetalmonitoringreactiveFHR1 648

  • | 35

    2.2(2)

    3. Prostaglandininhibitors:NSAIDs

    Indomethacin(3)

    50-10025-50

    620032

    48

    ductusarteriosus/

    48

    ductusarteriosus

    (repeatcourse)

    Terbutaline(Bricanyl)ampule(0.5/ 500/)

    Intermittentsubcutaneousinjection 0.25250(0.5)

    0.2520-30430

    0.253-4 24

    tachycardia-sensitivecardiacdiseases Poorlycontrolledhyperthyroidism Poorlycontrolleddiabetesmellitus

  • 36 |

    tocolysis

    - beta-adrenergicreceptoragonists

    calciumchannelblockersmagnesiumsulfate

    - tocolysis48-72

    - tocolysis

    4

    tocolysisplacentalabruptionintra-amnioticinfection

    contraction

    - tocolysisPPROMcontroversialdata

    prophylactictocolysis

    PPROM34chorioamnionitis

    tocolysis

    48corticosteroids

    MaintenanceTocolysis

    maintenancetocolysis

    pretermbirth

    neonataloutcome

    B.(Corticosteroids)(4)lungmaturity

    intracranialhemorrhage,necrotizing

    enterocolitis

  • | 37

    - 24-34()

    1.(singlecourse)pretermlabor

    PPROM

    - Betamethasone12

    242

    - Dexamethasone612

    4

    2. singlerescuecourse

    singlecoursepretermlabor

    734

    (chorioamnionitis)

    C.(Antibiotics)

    1. latencyPPROM(6)

    ampicillin2 erythromycin2506

    48ampicillin

    250erythromycinbase333

    87

    2. groupBstreptococciactive

    phase37(7)

  • 38 |

    penicill inG 5 2.5-34 ampicillin2 14

    penicillinvancomycin 112 clindamycin900 8

    amoxicillin-clavulanicacid necrotizingenterocolitis

    antibioticsprolongpregnancy intactmembrane

    3. chorioam-nionitis

    D.(Neuroprotection)

    magnesiumsulfateinclusioncriteria,treatmentregimen(8) (PatientSafetyChecklist)(9)

    240/7-276/76212(10)

  • | 39

    magnesiumsulfateneuroprotectiontocolyticagentmagnesiumsulfatetocolyticagent

    E.

    (11)

  • 40 |

    1. Maternity-Tocolyticagentsforthreatenedpretermlabour

    before34weeksgestation.NSWKidandFamilies,2011.http://

    www.health.nsw.gov.au/policies/pd/2011/pdf/PD2011_025.pdf

    2. SimhanHN,CanitisS,LockwoodCJ,BarssVA.Inhibitionofacute

    pretermlabour.UpToDate2015www.uptodate.com

    3. SimhanHN,BerghellaV.Pretermlaborandbirth.In:CreasyRK,

    ResnikR,IamsID,LockwoodCJ,MooreTR,GreeneMF,eds.

    Creasy&Resniksmaternalfetalmedicine:Principlesand

    practice.7thed.Philadelphia:ElsevierSaunders;2014:624.

    4. RoyalCollegeofObstetriciansandGynaecologists.Antenatal

    corticosteroidtopreventrespiratorydistresssyndrome.Guide-

    lineNo.7February2004.

    5. McKinlayCJ,CrowtherCA,MiddletonP,HardingJE.Repeat

    antenatalglucocorticoidsforwomenatriskofpreter

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