Baumgarten & grüber tocolysis index calculator

Uterine contractions
Diaphragms
Metrorrhagia
Cervical dilation


Index :

Baumgarten & grüber tocolysis index

Definition of a Threatened preterm labor (TPL)

 Birth, before 37 completed weeks, the 259th day of pregnancy (WHO 1993)

 Independent definition of intrauterine growth

 Limit of viability: 25 weeks

 Before 37 completed weeks: painful contractile activity of the uterus (≥ 2/10 minutes) + modification of the cervix → leads to premature delivery if untreated appropriate (membranes intact)

Interpretation of Baumgarten & grüber tocolysis index

The seriousness of a Threatened preterm labor (TPL) can be appreciated and quantified with a follow-up of the evolution by an index (sometimes called score or index) comprising four rated parameters each from zero to four points.

      The values retained are:

        Index ≤ 3: Slight threat.

        Index ≥ 4 and ≤ 5: Moderate threat.

        Index ≥ 6: Severe threat.

Impact of a Threatened preterm labor (TPL)

 Most important prematurity (22-27 W): 10%

 Intermediate prematurity (28-31 W): 10%

 The most frequent prematurity (80%) is the least serious (32-37 W)

Complications

 Infectious: are favored by the immaturity of the immune system.

 Lungs: Hyaline Membrane Disease, a consequence of insufficient synthesis of surfactant, may cause respiratory distress

 Digestive, neurological, ophthalmological

Become premature

 Growth delay compensated around 8 years

 Less good school performance on average: attention disorders, hyperactivity, disorders behavior and social relationships

Etiopathogenesis

 Uterine causes

 Congenital uterine abnormalities: uterine hypotrophy, double uterus

 Acquired uterine abnormalities: fibroids

 cervico-isthmic open bite:

 Congenital

 Acquired: traumatic cervical injury

 Diagnosis: Hegar 8 in the premenstrual phase

 Processing: strapping

 Genital infections: viral, bacterial or parasitic, vaginitis, cervicitis, chorioamnionitis

 Other pelvic pathologies: uterine trauma by intraoperative injury

 Ovary causes

 Fetus: multiple pregnancy, fetal malformations, fetal infection (sepsis, chorioamnionitis)

 Placenta: Placenta previa, retro-placental hematoma, placentitis/chorio-amnionitis

chorioangioma

 Membranes: premature rupture of membranes (10-15% of pregnancies)

 Amniotic fluid: polyhydramnios, amniotic infection

 General causes: vascular-renal syndromes, diabetes with polyhydramnios, infections (pyelonephritis, asymptomatic bacteriuria, listeriosis; viral hepatitis, malaria, toxoplasmosis, cytomegalovirus, periodontitis)

Physical examination

 < 37 weeks: painful or tender uterine contractions, blood loss.

 Vaginal examination: cervix: length < 1 cm, internal orifice dilation > 1 cm

 Abdominal palpation

 Cardiotocogram

 Vaginal ultrasound: length of the endocervical canal < 30 mm (normal 42 mm), orifice internal > 1 cm, prolapse of the membranes in the endocervix, thickness of the lower segment <0.6cm

 Baumgarten score: ≤ 3: mild (TPL), 4-5: moderate (TPL), ≥ 6: severe (TPL)

Threatened preterm labor (TPL) Prevention

 Detection of causes before pregnancy: surgical treatment of uterine malformations,

cerclage, anti-infective treatments, treatment of vascular-renal syndromes

 Relaxation