조기분만 PRETERM LAOBOR

목차

[1] Definitions.

[2] Impact of Preterm Birth.

[3] Causes of Preterm Birth.

[4] Identification of Women at Risk for Preterm Birth.

[5] Diagnosis of Preterm Birth.

[6] Antepartum Management.

[7] Methods Used to Inhibit Preterm Labor.

본문내용

ts.
* mechanisms.
- adrenergic receptors : the outer surface of the smooth m. cell membrane 에 위치.
→ 그 위치에서 specific agonist 와 receptor가 couple 이룸.
→ cell membrane에 있는 adenyl cyclase가 receptor stimulation에 의해 activation.
→ adenyl cyclase는 다음 반응을 enhance 시킴.
..ATP → cyclic AMP conversion.
→ 이 반응은 많은 reaction을 initiation 함.
..reduce the intracellular conecntratrion of ionized calcium.
..thereby prevent activation of contractile proteins.
① Ritodrine.
..serious side effects.
- maternal tachycardia.
- hypotension.
- apprehension.
- chest tightness or pain.
- electrocardiographic S-T segment depression.
- pulmonary edema.
- death.
..maternal metabolic effects.
- hyperglycemia.
- hyperinsulinemia (less diabetic).
- hypokalemia.
- lactic acid ketoacidosis.
..less serious but troublesome side effects.
- emesis.
- headaches.
- tremulousness.
- fever.
- hallucination.
② Terbutaline.
4) Magnesium Sulfate.
* ionic magnesium : in a sufficiently high concentration.
→ alter myometrial contractability.
⇒ its role : calcium antagonist.
- cervix dilatation 2 cm 이하시 → 88% successful.
- the period of inhibited labor : as short as 48 hours.
- the early latent phase of labor : relatively large doses I.V. 해야 effective.
* high-dosage magnesium sulfate 사용할 때에는,
..hypermagnesemia로 인한 toxic effect가 mother and infant에 작용할 수 있다.
⇒ must be monitored very closely.
5) Prostaglandin Inhibitors.
* antiprostaglandin agents 작용기전.
ⅰ. by inhibiting the synthesis of prostaglandins.
ⅱ. by blocking the action of prostaglandins on target organs.
- fetal complication - closure of the ductus arteriosus.
- necrotizing enterocolitis.
- intracranial hemorrhage.
6) Calcium Channel-blocking Drugs.
* nifedipine.
- relaxation similar to ritodrine & more effectively than magnesium.
- 초기 사용의 예.
..33주 이하 산모 10명에게서 최소 약 3일 정도의 분만 지연 관찰.
..no serious maternal or fetal side effects.
* combination of nifedipine ＆ magnisium.
- potentially dangerous.
.. nifedipine enhance the toxicity of magnesium to produce neuromuscular blockage
that can interfere with both pulmonary and cardiac function.
7) Atosiban.
8) Nitric Oxide Donor Drugs.
* nitric oxide.
- potent endogenous smooth muscle relaxant in vasculature, gut, uterus.

키워드

임신,   유아,   태아,   분만,   산부인과,   산모,   infant,   자궁