2012 年复旦大学上海医学院妇产科学系英文教案
妇产科
教研室（科）
徐焕
姓名
副主任医
职称
师
授课题目
早产
节次
2
授课对象
08 级 6 年制临床医学专业留学生班
授课
日期
2012-10-9
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一． Objectives
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2.
3.
4.
二．
Understanding the risk factors of preterm labor .
Understanding the diagnosis and treatment of preterm labor.
Understanding the definition and causes of premature of menbrane .
Understanding the diagnosis and treatment of premature of menbrane.
Contents of courses
1. Risk factors of preterm labor
Previous preterm delivery
Low socioeconomic status
Maternal age <18 years or >40 years
Preterm premature rupture of the membranes
Multiple gestation
Maternal history of one or more spontaneous
second-trimester abortions
Maternal complications (medical or obstetric)
Lack of prenatal care
2. Causes of preterm labor
Uterine causes
Myomata (particularly submucosal or subplacental)
Uterine septum
Bicornuate uterus
Cervical incompetence
Abnormal placentation
Infectious causes
Chorioamnionitis
Bacterial vaginosis
Asymptomatic bacteriuria
Acute pyelonephritis
Cervical/vaginal colonization
Fetal causes
Intrauterine fetal death
Intrauterine growth retardation
Congenital anomalies
3. Diagnosis of preterm labor
Documented uterine contractions(4 per 20 minutes or 8 per 60 minutes)
Documented cervical change (cervical effacement of 80% or cervical dilatation of 2cm or
more)
Forecast
uterine activity monitoring.
Ultrasound Examination of Cervical length
Fetal Fibronectin
4. Treatments of preterm labor
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三．Teaching Plan and Time Distribution
（一） Contents and time plan
1． Risk factors of preterm labor:10min
2. Causes of preterm labor:10min
3. Diagnosis of preterm labor:10min
4. Treatments of preterm labor :10min
Question and Answer 5 min
5. Definition and predisposing factors :5min
Premature rupture of the membranes (PROM) is defined as amniorrhexis
(spontaneous rupture of membranes) prior to the onset of labor at any stage of gestation
Incidence:PROM occurs in about 10-15% of all delivery;PROM is associated with 10% of
term pregnancy
6.Causes: The cause of PROM is not clearly understood, perhaps associated with
the follow factors:Trauma、Sexual intercourse (particularly in the late gestational weeks)、 lax
of internal os of uterine、Vaginal infection due to bacteria, virus, TOXO, CMV, HPV, HSV, et
al STDs sexually transmitted diseases play an important role in the cause of PROM, because
such infections are more commonly found in women with PROM than in those without PROM
Increased of intra-uterine pressure (such as multiple pregnancy and hydraminios)、
Abnormalities in presentation and position、Smoking the risk of PROM is at lease doubled in
women who smoke during pregnancy、Other factors for PROM include ：Prior PROM、A short
cervical length、Prior preterm delivery 、Bleeding in early pregnancy 10min
7. Diagnosis: :10min
8. Managements: Conservative expectant management
Management of chorioamnionitis
Tocolytic therapy
Use of corticosteroids
Labor and delivery
Surfactant therapy
If PROM occurs at term(37 weeks’ gestational age or more), awaiting the onset of spontaneous
labor for 12-24h should be considered, because spontaneous labor will ensue in 90% of patients
within 24 hours
If the time from PROM to the inset of labor exceeds 24h, induction of labor should be considered
by oxytocin
If the evaluation suggests intrauterine infection or chorioamnionitis, antibiotic and delivery are
indicated and the antibiotic prescribed should have a broad spectrum of coverage
If the infant is a preterm breech, and the onset of PROM occurs after 30 weeks’ of gestational,
possibly by ceasarean delivery
If the gestational age is less 30 weeks’, vaginal deliverly should be chosen
If the fetus is significantlypreterm and the absence of infection, expectant management is generally
chosen；Patients must be assessed carefully；Uterine tenderness daily；Electronic fetal monitoring
used frequently；Fetal movement monitoring by the mother；Frequent ultrasound assessment helps
to determine amniotic fluid；Frequently WBC counts, usually daily for several days；Antibiotic
should be used and antibiotic therapy may prolong the latency period after preterm PROM and
improve the perinatal outcome.
Question and Answer: 5 min 4
（二）Key points and Difficulty
Key points：Diagnosis of preterm labor and premature of membrane.
Difficulty：Treatment of preterm labor and premature of membrane；
（三）Key words
Pretern Labor
Premature of membrane
（四）Teaching tools（Figure、table、model、video and CAI etc.）
(Special Request from Dpt. of Teaching and Research )
N/A
（五）Questions？
1．What are the diagnosis of preterm labor?
2．What are the causes and diagnosis of premature of membrane?
(六) References: textbook, supplementary materials, recommended reading;
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