Medicine an Surgery notes

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PRETERM LABOREssentials of diagnosisEstimated gestational age of greater than 20 weeks and less than 37 weeks.Regular uterine contractions at frequent intervals.Documented cervical change or appreciable cervical dilation or effacement (at least 2 cm without previous examination).General ConsiderationsPreterm labor is defined as labor occurring after 20 weeks' but before 37 weeks' gestation.Contractions need to be regular and at frequent intervals.Generally, more than 4 contractions an hour are needed to cause cervical change.There must be demonstrated cervical effacement or dilationThe uterine contractions need not be painful to cause cervical change and may manifest themselves as abdominal tightening, lower back pain, or pelvic pressurePreterm labor complicates 10-15% of all pregnancies. It is the number one cause of neonatal morbidity and mortality and causes 75% of neonatal deaths that are not due to congenital anomalies.PathogenesisMany obstetric, medical, and anatomic disorders are associated with preterm labor. The cause of preterm labor in 50% of pregnancies, however, is idiopathic.Risk factors associated with preterm labor. a) Obstetric complications In previous or current pregnancy Severe hypertensive state of pregnancy Anatomic disorders of the placenta (eg, abruptio placentae, placenta previa, circumvallate placenta) Placental insufficiency Premature rupture of membranes Polyhydramnios or oligohydramnios Previous premature or low-bi

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