1.

Clinical symptoms and signs

of Preterm Labour
2. Difference between Threatened
and Actual Preterm Labour
3. PPROM

By :
S.Kishore
Final Year MBBS
CLINICAL SYMPTOMS OF PRETERM
1.Contractions : Early differentiation between true and false labor is difficult .
2.Pelvic pressure
3.Menstrual-like cramps
4.Watery vaginal discharge
5.Lower back pain
SIGNS OF PRETERM
CERVICAL CHANGE :

Asymptomatic cervical dilation after mid pregnancy is suspected to be a preterm delivery risk
factor .

Threatened preterm labour : Only uterine contractions are there , can use tocolytics to delay
labour .

Actual Preterm labour : No use of tocolytics.

DIFFERENCE BETWEEN ACTUAL AND THREATENED
PRETERM LABOUR PAINS

Features of Actual Preterm Labour :

1. Painful uterine contractions at regular intervals

2. Frequency of contractions increase gradually
3. Intensity and duration of contractions increase progressively
4. Associated with “show”
5. Progressive effacement and dilatation of the cervix
6. Descent of the presenting part
7. Formation of the “bag of forewaters”
8. Not relieved by enema or sedatives.
 PRETERM PREMATURE RUPTURE OF MEMBRANES

Preterm premature rupture of membranes (PPROM) is defined as the rupture of membranes

before 37 weeks of gestation.

INCIDENCE: PPROM occurs in approximately

10% of all pregnancies .
CAUSES:
(1) Increased friability of the membranes;
(2) Decreased tensile strength of the membranes
(3) Polyhydramnios
(4) Cervical incompetence
(5) Multiple Pregnancy
(6) Infection—Chorioamnionitis,urinary tract
infection and lower genital tract infection
(7) Cervical length < 2.5 cm
(8) Prior preterm labor
(9) Low BMI (< 19 kg/m2 ).
SYMPTOMS AND DIAGNOSIS :
Escape of watery discharge per vaginum either in the form of a gush or slow leak .

DIFFERENTIAL DIAGNOSIS :
(a) Hydrorrhea gravidarum—a state where periodic watery discharge occurs probably due to
excessive decidual glandular secretion .

(b) Incontinence of urine especially in later months.

CONFIRMATION OF DIAGNOSIS

(1) Sterile speculum examination to visualize the leakage of amniotic fluid. Fluid may be seen
coming from the cervix or forming a pool in the posterior fornix. There may be a gush of
fluid from the cervical os when the woman is asked to cough .
 (2) Detection of pH : done by litmus or Nitrazine paper.

●
Normal vaginal pH during pregnancy is 4.5–5.5
●
Amniotic fluid ( with a pH of 7.3-7.4 ).
●
Nitrazine paper turns from yellow to blue at pH > 6 .
●
Blood and some vaginal infections may give false positive results .
(3) Ferning test :
Amniotic fluid crystallizes and leaves a Fern - leaf pattern .

Positive Ferning Test

OTHER TESTS :
(1) Ultrasound examination may show decreased liquor or absence of liquor .

(2) Centrifuged cells stained with 0.1% Nile blue sulfate shows orange blue coloration of the
cells (exfoliated fat containing cells from sebaceous glands of the fetus) .

(3) AmniSure - A rapid immunoassay .

DANGERS :
FETAL COMPLICATIONS :

The implications are less serious when the rupture occurs near term than earlier in pregnancy.
(1) PPROM is one of the important causes of preterm labor and prematurity
(2) Chance of ascending infection is more if labor fails to start within 24 hours.
Liquor gets infected (chorioamnionitis) and fetal infection supervenes .
(3) Cord prolapse - when associated with malpresentation .
(4) Continuous escape of liquor for long duration may lead to dry labor .
(5) Placental abruption
(6) Fetal pulmonary hypoplasia, especially when associated with oligohydramnios .
(7) Neonatal sepsis .
(8) Perinatal morbidities (cerebral palsy)
MATERNAL COMPLICATIONS :

1. Chorioamnionitis
2. Placental abruption
3. Retained placenta
4. Endometritis
5. Maternal sepsis
6. Maternal death
BIBLIOGRAPHY :

1.Books: Williams,Mudaliar and Dutta

2. https://commons.wikimedia.org/
3. https://www.sciencephoto.com/
4. https://www.uptodate.com/
5. Google