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preterm-labour-pathogenesis-maternal-complications

Preterm Labour: Pathogenesis & Maternal Complications Cervical Procedures Removing part of the cervix Ex. Cone biopsy, cervical LEEP Genitourinary Infections E.g. Urinary tract infection, bacterial vaginosis, chorioamnionitis, abnormal vaginal flora ↑ bacterial colonization of fetal membrane ↑ bacterial enzymes and immune reactions Antepartum Hemorrhage ↑ risk placental abruption ↑ decidual tissue factor release Activates coagulation cascade ↑ thrombin ↑ proteases Substance Use Smoking or cocaine use Vasoconstriction in uterine circulation, endothelial dysfunction Placental hypoperfusion and ischemia ↑ fetal ACTH ↑ placental prostaglandins Maternal Stress Malnutrition, depression, trauma- related disorders, work-related stress ↑ cortisol ↑ placental corticotropin releasing hormone Uterine Abnormalities Mullerian duct anomalies: congenital abnormalities in uterine shape Septate uterus: ridge of tissue dividing uterus into two horns Intracavitary leiomyoma: benign mass inside uterus ↑ Uterine volume Maternal Genome Family hx or personal hx of preterm birth, previous preterm premature rupture of membrane ↓cervical stroma & ↑cervical scarring ↓ cervical glandsà ↓ mucous production ↑risk of infection ↑ inflammation ↑prostaglandins Cervical collagen degradation Rapid growth exceeds blood supply Ischemia & necrosis of fetal tissue ↑prostaglandins and cytokines ↓ functional volume of uterine cavity Multifetal pregnancy, poly- hydramnios ↓tensile strength and plasticity Uterine stretch Upregulation of oxytocin receptors Genes for ↑ risk Mechanism unknown Cervical Insufficiency Pathologic cervical dilation and/or effacement (thinning) Authors: Skye Russell Reviewers: Danielle Chang, Crystal Liu, Yan Yu*, Nicholas Papalia* *MD at time of publication Digest and weaken amniotic membrane Preterm Premature Rupture of Membranes ↑ myometrial sensitivity to oxytocin Uterine contractions Preterm Labour Uterine contractions and cervical change occurring <37wk gestational age ↑ Risk of future preterm labour and preterm birth Abbreviations: • LEEP – Loop electrosurgical excision procedure • ACTH – adrenocorticotropic hormone Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published July 12, 2020 on www.thecalgaryguide.com