22 feb. MANAGEMENT OF PREMATURE BIRTH: TREATMENT AND TOCOLYSIS
Anca A Simionescu
Universitatea de Medicina si Farmacie Carol Davila , Spitalul Clinic Filantropia
Rezumat: Managementul nasterii premature: tratament si tocoliză
Introducere : Nasterea prematura ramine in toata lumea o cauza care nu poate fi evitata de mortalitate si morbiditate neonatala si o cauza majora de morbiditate pentru gravide, in ciuda eforturilor de screening al pacientelor cu risc crescut prin examinarea ecografica.
Material si metode : Prezentam o serie pilot de 6 paciente primipare cu sarcina intre 28-32 de saptamini cu amenintare de nastere prematura severa ( lungimea colului masurata ecografic intre 15 – 20mm ) la care s-a efectuat tratament tocolitic utilizind betamimetice si progesteron , in medicatie unica sau asociata. In medicina neonatala exista un progres major pentru ingrijirea nou-nascutilor prematuri , mai ales al prematurilor extremi , nascuti inainte de 32 de saptamini. In caz de nastere prematura, tocoliticele, teoretic, pot opri travaliul si prelungi sarcina, pentru a permite efectuarea corticoterapiei pentru maturarea fetala pulmonara si pentru a permite transferul in utero in maternitati cu serviciu de reanimare neonatala. Rezultate : Exceptind 2 paciente, nasterile au avut loc in urmatoarele 10 zile de la momentul prezentarii. In concluzie, este foarte dificil de dovedit rolul tocoliticelor in prelungirea sarcinii in iminenta de nastere prematura; ar fi important de monitorizat prin statistici locale aceste cazuri si de stabilit protocoale pentru aceste patologii.
Abstract
Background and objectives: In all countries around the world, preterm birth is still a nonavoidable cause of mortality and morbidity for newborns and a major cause of morbidity for pregnant women; despite the cervical screening policy for high risk pregnancies.
Material and methods: A pilot retrospective descriptive study of 6 cases of pregnant primigravida patients between 28-32 weeks was conducted; who were admitted to hospital for premature birth with a cervical functional length at 22 week’s ultrasound of 15-20 mm. In cases of risk of premature birth, intravaginal progesterone was administered and in the case of admission to hospital, an intravenous betamimetic treatment was administered. Advances in neonatal care have improved the outcome of premature newborns, especially the care of very premature newborns born before 32 weeks. In the case of prematurity, theoretical , tocolytic drugs can inhibit labour and prolonged pregnancy . This may gain time to permit antenatal corticosteroid administration for fetal lung maturation , and allow time for intra-uterine transfer to a hospital with neonatal intensive care facilities.
Results Four patients whose baby was delivered a short time after admission to hospital ( less than 10 days) and 2 patients after one month.
Conclusion: It is unclear whether tocolytic drugs – single or combination for preterm labour are more advantageous for prolonged pregnancy . Tocolytic medication is safely used when standard protocols are followed according to local polities; we need to improve statistical collection of the data and pluridisciplinary informations.
Keywords:nastere prematură, medicamente tocolitice, progesteron, ritrodină
