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Year 2020 - Volume 30 - Issue 3

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GUIDELINE ON PRETERM LABOR AND DELIVERY by the Society of Specialists in Perinatology (Perinatoloji Uzmanları Derneği-PUDER), Turkey
Received: 01 Sep 2020 | Accepted: 27 Sep 2020 | Available online: 12 Nov 2020
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Metin ALTAYa, Merih BAYRAMb, Aydan BİRİc, Esra ESİM BÜYÜKBAYRAKd, Özgür DERENe, Fedi ERCANf, Derya EROĞLUg, Aytül ÇORBACIOĞLU ESMER h , Cihan İNANı, Hakan KANITi, K. Emre KARAŞAHİNj, M. Tamer MUNGANk, Özlem PATAl, Berkan SAYALm, Hakan TİMURn, Miğraci TOSUNa, Mert TURĞALö, Nihal ŞAHİN UYSALp, Filiz F. YANIKr
aPrivate Clinic, Ankara, TURKEY
bDivision of Perinatology, Gazi University Faculty of Medicine, Ankara, TURKEY
cDivision of Perinatology, Koru Hospitals, Ankara, TURKEY
dDivision of Perinatology, Marmara University Faculty of Medicine, İstanbul, TURKEY
eDivision of Perinatology, Hacettepe University Faculty of Medicine, Ankara, TURKEY
fDivision of Perinatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, TURKEY
gDivision of Perinatology, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, TURKEY
hDivision of Perinatology, Biruni University Faculty of Medicine, İstanbul, TURKEY
ıDivision of Perinatology, Trakya University Faculty of Medicine, Edirne, TURKEY
iPrivate Clinic, İzmir, TURKEY
jDivision of Perinatology, Gülhane Faculty of Medicine, Ankara, TURKEY
kDivision of Perinatology, Koru Hospitals, Ankara, TURKEY
lDivision of Perinatology, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, TURKEY
mDivision of Perinatology, Health Science University Antalya Training and Research Hospital, Antalya, TURKEY
nDivision of Perinatology, Ordu University Training and Researh Hospital, Ordu, TURKEY
oDivision of Perinatology, Ondokuz Mayıs University Faculty of Medicine, Samsun, TURKEY
öDivision of Perinatology, Koç University Faculty of Medicine, İstanbul, TURKEY
pDivision of Perinatology, Başkent University Faculty of Medicine, Ankara, TURKEY
rPrivate Clinic, Ankara, TURKEY
J Clin Obstet Gynecol. 2020;30(3):118-30
DOI: 10.5336/jcog.2020-78741
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
 Preterm delivery (PTD) occurs between 200/7-366/7 weeks of pregnancy and is a major cause of perinatal mortality and morbidity. The prevalence is around 12% in Turkey, ranging between 10 to 15% in different centers. Indicated preterm deliveries due to maternal or fetal reasons constitute approximately 20-30% of the total. The rest occur as a result of spontaneous preterm labor (PTL) or preterm prelabor rupture of the membranes (PPROM), about half and half. Although etiology of spontaneous preterm birth has not been fully elucidated, several risk factors are defined. History of PTD and short cervix are two most important risk factors, particularly in singleton pregnancies. If the cervical length is measured to be <25 mm via transvaginal ultrasonography before the 32nd gestational week, it is defined as short cervix. In women with prior PTD, progesterone preparations are recommended between 16th-36th gestational weeks and cervical length is monitorized; additional preventive measures may be required if short cervix is diagnosed. In women without prior PTD, we universally offer transvaginal ultrasonographic cervical length measurement at the time of midtrimester fetal anomaly scan. When short cervix is determined in such cases, cervical cerclage, vaginal progesterone, cervical pessary, alone or in combination, may be recommended depending on the measurement and the gestational age. Asymptomatically dilated cervix, PTL, and PPROM are generally managed according to the gestational age on a case-by-case basis. Data are limited in twin and higher order multiple pregnancies to recommend standart prevention and management protocols.
KEYWORDS: Premature birth; obstetric labor, premature; preterm premature rupture of the membranes
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