Preterm

Preterm Labour
Labour
Ddungu Ahmed
Nabasa James Musiime
Preterm Labour and Preterm
Birth
Objectives

• recognize preterm labour

• manage preterm labour
• apply preventive strategies for preterm birth
Clinical Definition
– Preterm Labour:
• regular uterine contractions accompanied by progressive
cervical dilatation and/or effacement at less than 37
weeks.
Definition
– Preterm Birth:
• any birth regardless of weight occurring before 37
completed weeks from the first day of last menstrual
period (LMP)
• increased perinatal morbidity and mortality is associated
with birth < 34 weeks
• Epidemiology
• 7% labours are preterm
• 30% babies born at 24wks survive (UK)
• 80% babies born at 28wks survive (UK)
 Outcome of Extreme Preterm Delivery
Survival Rate / NICU admissions (%) Neurosensory Impairment / Survivors (%)

100
80

60
%
40
20

0
22 23 24 25 26 27 28 >29
Gestational Age (w eeks)
McMaster University 2003
Etiology
• APH
• preterm pre-labour rupture of membranes
(PPROM)
• multiple pregnancy
• polyhydramnios
• incompetent cervix
• uterine anomaly
• fetal anomaly
• Idiopathic
• Chorioamnionitis
• Systemic dz (pyelonephritis)
• Drug abuse - cocaine
• Trauma to abdomen
• procedures – e.g amnioscentesis
Additional Risk Factors
– prior preterm birth
– bacteriuria
– maternal weight/age/smoking/stress
– bacterial vaginosis (BV) in women with a prior preterm
birth increases the risk of preterm PROM and low birth
weight (LBW)
– Low socio economic class
– malnutrition
 Clinical Features
• +/- watery vaginal discharge
• +/- PV Bleeding
• +/- back ache
• +/- low abd. Pain
• +/- reduced fetal movements
• Signs of labour
- Painful regular contractions
- rupture of membranes
- Cx effacement
- Cx dilatation
Diagnosis
• history: contractions, back ache, bleeding, uterine
anomalies ,previous preterm labour, etc
• establish dates: LNMP,EDD, U/S at 20wks
• identify risk factors
• Physical exam:
• Abd. exam: tenderness, guarding, masses, contractns
• Obstetric exam
• V/E:PV discharge, Cx dilatn, effacement
 investigations
• dx: mainly clinical
• But inv. To treat possible causes
- CBC+ ESR
- High vaginal swab
- Blood cultures
- urinalysis
- Amnioscentesis
- TV Ultrasound
 Supportive mgt
• Correct dehydration
• analgesia
• Allay anxiety
• ABCs
 Definitive management
• Consists of tocolysis or allowing labour to
progress
• Tocolysis:aims to delay lbr till steroids tkn effect
• Attempt tocolysis if:
• GA< 37wks
• Cx <3cm
• No amnionitis, pre-eclampsia or active bleeding
• No fetal distress
• Give steroids: dexa 12mg bd or betamethasone
 Tocolytics
• Beta agonists: ritodrine, salbutamol,
terbutaline
• Ca channel blockers: nifedipine
• NSAIDS: rectal indomethacin
• Glceryltrinitrate :transdermal or IM
• 17OH Progesterone (obsolete in devpd world)
• Dose: salbutamol 10mg in 1L IV 10drops/min,
increase by 10drops/30min til thy stop
• indomethacin:100mg then 2mg 6hrly for 48hrs
 Allow labour to progress
• If GA>37, CX>3cm, active bldg,fetal distress,
amnionitis or pre eclampsia
• Monitor lb with partograph
• Prep mgt for preterm/LBW baby
&rescusitation
• Don’t rupture membr early
• Small prematures may be delivered in their
sacs
• C/S if twins or higher order multiple gestation