Hi, this is Tom, and in this episode I'm going to be going through

Prematurity, and you can find notes at 0.0.finals.com slash prematureity, and in the

0 to finals pediatrics book, and you can find flashcards and questions at members.0 tofinals.com. So let's jump straight in.

Prematurity is defined as birth before 37 weeks gestation. The more premature the baby,

the worse the outcomes. The prognosis improves with each additional week of gestation. Resuscitation in

babies under 500 grams or 24 weeks gestation needs to be considered very carefully. The World

Health Organization, or WHO, classifies prematurity as when they're under 28 weeks,

this is extreme preterm, 28 to 32 weeks is very preterm, and 32 to 37 weeks is moderate to late preterm.

Let's talk about the risk factors.

The risk factors for prematurity include social deprivation, smoking, alcohol or drug use,

an overweight or underweight mother, maternal comorbidities, for example, diabetes or high blood

pressure, multiple pregnancy, including twins, and a personal or family history of prematurity.

Next let's talk about management before birth.

In women with a history of preterm birth or an ultrasound demonstrating a cervical length

of 25 millimeters or less before 24 weeks gestation, there are two options for trying to delay birth.

Prophylactic vaginal progesterone, which involves putting a progesterone suppository in the vagina

to discourage labour, or prophylactic circlage, which involves placing a suture in the cervix to hold it closed.

Where preterm labour is suspected or confirmed, there are several options for improving the

outcomes, and these include tocholysis with nephedapine, which is a calcium channel blocker that suppresses labor.

Maternal corticosteroids, which are offered before 35 weeks, gestation to reduce neonatal

respiratory distress and mortality.

Intravenous magnesium sulfate, which is offered before 34 weeks gestation

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