Preterm labor – an unresolved problem of the XXI century

The article discusses one of the most significant problems in the modern obstetric practice – preterm labor (PL). The upward trend in PL worldwide is related to an increase number of multiple pregnancies due to in vitro fertilization (IVF). PL is one of the main causes of early neonatal mortality and disability in children, also increases the survival rate of newborns with extremely low birth weight, and therefore it significantly changes the structure of surviving premature infants' morbidity. The greatest threat is represented by the «threshold» stages of the disease, with the development of which the process becomes almost irreversible and requires immediate treatment. To improve the perinatal outcomes of PL, the authors draw attention to two problems: first of them – to understand the mechanism of PL, the second one-to work out tactics that allow to carry out measures that can delay, prevent the distress syndrome, and improve fetal condition at any stage of the disease. Key words: preterm birth, in vitro fertilization, quality of life, retinopathy of prematurity.

Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Background: Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome. Objective: To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL. Materials and Methods: This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20mg of rapid release nifedipine orally. If uterine contraction continued, a 10mg dose was repeated every 20 min with a maximum of 40mg within the first hour. After completing the first hour, 20mg was given every 4–6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200mg daily. Results: Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13 ± 5.08 days in group A while 29.73 ± 3.10 days in group B. (p0.001). Conclusion: Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions. Key words: Preterm labor, Tocolytics, Nifedipine, Progesterone.

Pengaruh Perawatan Metode Kanguru terhadap Respons Fisiologis Bayi Prematur

Saat ini, perawatan metode kanguru mulai dianjurkan bagi bayi prematur karena kelahiran prematur dan bayi dengan berat badan lahir rendah merupakan salah satu penyebab kematian bayi terbesar. Tujuan penelitian ini adalah untuk mengetahui pengaruh perawatan metode kanguru terhadaprespons fisiologis bayi prematur. Desain quasi experiment one group pre and post-test dilakukan di 2 rumah sakit di Jakarta. Sebanyak 16 bayi prematur yang memenuhi kriteria inklusi dipilih sebagai sampel. Hasil penelitian menunjukkan bahwa terdapat pengaruh yang bermakna dari perawatanmetode kanguru terhadap respons fisiologis bayi prematur seperti peningkatan suhu tubuh ke arah suhu nornal (p value = 0,000), peningkatan frekuensi denyut jantung ke arah normal (p value = 0,003), dan peningkatan saturasi oksigen ke arah normal (p value = 0,023). Oleh karena itu, metodeperawatan kanguru merupakan cara yang efektif, mudah, dan murah untuk merawat bayi prematur.Kata kunci: Bayi prematur, perawatan metode kanguru, fisiologis bayiAbstractAs premature birth and low birth weight are the main cause of neonatal mortality, kangaroo mother care is now suggested to care premature infants. The purpose of this study was to identify the effect of kangaroo mother care on physiological response of preterm infants. A quasi experiment designwith one group pre and post test design was conducted in two hospitals in Jakarta. Sixteen preterm infants matching the inclusive criteria were selected as sample. The study found significant effect of kangaroo mother care intervention on physiological response of preterm infants, i.e. increasing body temperature to normal (p value = 0,000), increasing heartrate to normal (p value = 0,003), and increasing oxygen saturation (p value = 0,023). Therefore, the kangaroo mother care is therefore an effective, simple, and cheap method to care the preterm infants. Key words: Preterm infants, kangaroo mother care, physiological responses

Indication of Caesarean Section Operation in Preterm Pregnancy and Its Outcome – A Study of 100 Cases

A prospective study of 100 cases of preterm pregnancy was done in the Department of Obstetrics & Gynaecology of Dhaka Medical College Hospital and Mitford Hospital, Dhaka from September 2002 to August 2003. The incidence and indications for caesarean section operation were eclampsia 24%, preeclampsia 20%, antepartum haemorrhage (APH) 15%, premature rupture of membrane (PROM) 8%, PROM with chorioamnionitis 4%, preterm labour with previous caesarean section 9%, foetal distress with labour pain 7%, less foetal movement 6%, malpresentation with cord prolapse 3%, multiple pregnancy 2% and diabetes mellitus with polyhydramnios 2%. Emergency caesarean section was done in 98 cases and elective operation in 2 cases. Live birth was 93% and perinatal mortality was 32%. Neonatal morbiditites were prematurity and birth asphyxia. Maternal mortality in preterm caesarean section was 16%. Key words: Preterm pregnancy; Caesarean section; Indication; Outcome. DOI: 10.3329/jdmc.v18i2.6271 J Dhaka Med Coll. 2009; 18(2) : 124-126