红字理解的对吗？

PHYSICAL FINDINGS & CLINICAL PRESENTATION 

Presenting symptoms include increased pelvic pressure, abdominal cramping or contractions, increased vaginal discharge, vaginal bleeding or spotting, or leakage of fluid. 

ETIOLOGY 

Causes of premature labor are varied and often difficult to determine. Premature labor may be secondary to infection, systemic illness, trauma, anatomic abnormalities (i.e., uterine anomaly), or a combination of factors. It is thought that cervical ripening is the most common first step to premature labor or delivery. Subsequently, decidual-membrane activation occurs followed by contractions (Box 1). 

DIAGNOSIS 

DIFFERENTIAL DIAGNOSIS 

The differential diagnosis for preterm labor should include preterm rupture of membranes, preterm contractions (contractions before 37 wk gestation that do not result in cervical change), and abdominal pain or cramping secondary to other medical conditions. There are many medical conditions that may cause preterm contractions or premature labor. Treating some of these underlying conditions may improve the prognosis for stopping the preterm labor. 

Possible medical conditions include: 

• Infection

1. Chorioamnionitis

2. Genital tract infections, including bacterial vaginosis, gonorrhea, chlamydia 

3. Urinary tract infections, including pyelonephritis, cystitis, or asymptomatic bacteriuria 

4. Gastroenteritis 

• Trauma

• Placental abruption

• Illicit drug use

• Preterm premature rupture of membranes

• Appendicitis

• Nephrolithiasis

• Pancreatitis

• Cholelithiasis

• Uterine fibroids

WORKUP

 • History and physical exam to rule out trauma, abuse, other causes of abdominal pain, and infection • Fetal heart rate monitoring and tocometry to determine fetal status and contraction frequency

• Speculum exam to visually assess the cervix and assess for rupture of membranes, bleeding, infection, or advanced cervical dilation 

1. If the patient is <35 wk gestation, a Fetal Fibronectin (FFN) test should be collected prior to performing a digital exam or transvaginal ultrasound. A FFN test can help predict preterm delivery if the patient has a cervical length on transvaginal ultrasound of <30 mm 

• Digital exam in the unruptured patient with normal placentation to determine cervical dilation and effacement, and fetal station

体格检查和临床表现

症状包括盆腔压升高、腹部绞痛或宫缩、阴道排出物增多、阴道流血或点滴出血、或漏液（即破水）。

病因

早产的原因多种多样，往往难以确定。早产可能继发于感染、全身性疾病、创伤、解剖异常（如子宫异常）或多种因素的结合。一般认为，宫颈成熟是早产或分娩最常见的第一步。随之，宫缩后蜕膜激活发生（框式图1）。

诊断

鉴别诊断

对早产的鉴别诊断应包括胎膜破裂、早产宫缩（妊娠37周之前的宫缩，但不导致宫颈改变）、以及继发于其他疾病的腹痛或痉挛。有许多疾病可能导致早产宫缩或早产。治疗这些潜在的疾病可以改善终止早产的预后。

可能的医疗状况包括:

l 感染

1.绒毛膜羊膜炎

2.包括细菌性阴道病、淋病、衣原体在内的生殖道感染

3.包括肾盂肾炎、膀胱炎或无症状菌尿在内的尿路感染

4.胃肠炎

l 创伤

l 胎盘早剥

l 非法药物使用

l 胎膜早破

l 阑尾炎

l 肾结石

l 胰腺炎

l 胆石症

l 子宫肌瘤

检查

l 病史和体格检查以排除外伤、虐待、其他原因导致的腹痛以及感染

l 胎心率监测和宫缩测量计确定胎儿的状态和宫缩频率

l 窥器检查视觉评估宫颈和评估胎膜破裂、出血、感染或进展性的宫颈扩张

1.如果患者妊娠周期小于35周，在进行指检或经阴道超声检查之前，应做胎儿纤连蛋白（FFN）测试。如果患者宫颈长度小于30 mm，FFN测试可以帮助预测早产。

l 对胎盘正常的胎膜未破裂患者进行指检，以确定宫颈扩张和消失以及胎儿位置

红字理解的对吗？尤其是improve the prognosis for stopping the preterm labor. 改善终止早产的预后？总觉得怪怪的