Preterm Birth: Case Study

							Infection & Preterm Birth
               Objectives
• Understand magnitude of problem of PTB.

• Gain understanding of role of infection in
  spontaneous PTB.

• Overview of clinical decision making and
  “art” of medicine regarding PTB.
Rate of PTB ~ 10%
and increasing

Primary cause of
neonatal morbidity
and mortality
Economic Impact of PTB
       Risk Factors for Preterm
              Delivery

•   Previous obstetric history
•   Race/ethnicity
•   Multiple gestation
•   Incompetent cervix
•   Congenital Anomalies
       Risk Factors for Preterm
              Delivery

•   Substance abuse
•   Pre-Pregnancy Weight
•   Stress
•   Maternal Age
•   INFECTION
         Infection and PTB
• 40% of PTB due to infection
• ↓ Gestational Age   Infection
• Only pathologic process with firm causal
  link established
• Fetal infection & inflammation  Cerebral
  palsy & chronic lung disease
  Infection & PTB: Pathophysiology

                            Invasion of Amniotic Fluid


Fetal Invasion


                                Localized Inflammatory
                                Reaction




                     Change in flora
            Case Study 1
• 24 yo at 23 weeks EGA with gush of fluid
• Bacterial vaginosis diagnosed on vaginal
  exam
• Admitted, antibiotics started, counseled
• Family opts for expectant management
               Case Study 1

•   Develops fever and uterine tenderness
•   Contractions increased
•   Vaginal delivery of 800 gm baby boy
•   Severe respiratory distress, multi-organ
    system failure.
             Case Study 2
• 34 yo at 35 weeks with contractions and
  cervical dilation.
• Group B Strep isolated from vagina at last
  prenatal visit.
              Case Study 2
•   Amniocentesis showed mature fetal lungs
•   Antibiotics continued
•   Vaginal delivery
•   Baby weighted 5#5oz; stayed in nursery
    for 5 days then discharged to home. No
    long term sequelae.
                 Case Study 3
• 30 yo at 26 weeks presenting with flu-like
  illness, rash, vaginal discharge and uterine
  cramping.



       Primary Genital Herpes
           Case Study 3
• Intravenous anti-viral medication
• Tocolytics to relax uterus
• Contractions continued and membranes
  ruptured
• Cesarean delivery of 2.5# infant
             Case Study 3
•   Support in NICU
•   IV antivirals
•   Spinal tap
•   Disseminated HSV