PRETERM

LABOR
By : BHAWESH KUMAR
Roll No: 11
Batch : 14th
WHAT IS PRETERM LABOR?

 Preterm labor is defined as regular contractions of the uterus

resulting in the changes in the cervix that start before 37 weeks of
pregnancy.
 Changes in the cervix include effacement and dilation.
WHAT IS PRETERM LABOR?

 By WHO preterm labor is defined as onset of labor prior to the

completion of 37 weeks of gestation, in a pregnancy beyond 20
weeks of gestation
 Preterm birth: when birth occurs between 20 weeks of pregnancy &
37 weeks of pregnancy it is called preterm birth
 If uterine contractions are perceived in the absence of cervical
change the condition is called Threatened preterm labor. Nearly
50 – 60% of preterm births occur following spontaneous labor. 30%
due to preterm premature rupture of membranes. Rest are iatrogenic
terminations for maternal or fetal benefit
RISK FACTORS
 Having a previous preterm birth.
 Having a short cervix.
 Short interval between pregnancies.
 History of surgeries of uterus & cervix.
 Multiple gestations.
 Vaginal bleeding.
 Smoking and alcohol abuse.
SIGN & SYMPTOMS
1. Change in the type of vaginal discharge ( watery , mucus or bloody).
2. Increase in the amount of discharge.
3. Pelvic or lower abdominal pressure.
4. Dull backache.
5. Mild abdominal cramps with or without diarrhea.
6. Regular or frequent contractions or uterine tightening, often painless
7. Ruptured membranes.
DIAGNOSTIC CRITERIA
 Gestational age between 24 – 37 weeks
 Uterine contractions ≥ 4 every 20 minutes OR ≥ 8 in 6 minutes
 CERVICAL CHANGE:
1. Cervical dilation of ≥ 3cm OR
2. Cervical length< 20mm on TV Ultrasound OR
3. Cervical length 20 to < 30 mm on TVUS + positive fetal fibronectin
 MANAGEMENT
TOCOLYTIC DRUGS
 INDOMETHACIN
1. Prostaglandin Inhibitor
2. First—line therapy 24 to 32 weeks
3. Avoided beyond 72 hours(constriction of ductus arteriosus and
oligohydramnios)
TOCOLYTIC DRUGS
 NIFEDIPINE
1. Calcium channel blocker
2. Often used when indomethacin fails
3. First-line if contraindication to indomethacin
4. Causes hypotension, flushing and fatigue.
 RITODRINE OR TERBUTALINE (BETA-2 AGONIST)
 MEGNESIUM SULPHATE
CORTICOSTEROIDS
 If the period is between weeks 24 and 34, the health care provider
might recommend an injection of potent steroids to speed the
baby’s lung maturity.
 After week 34, the baby’s lungs might be mature enough for
delivery without steroids.
 PREVENTION
 For some women, a surgical procedure Known as cervical cerclage can help to
prevent premature birth during this procedure,the cervix is stitched closed with
strong sutures .
 Typically the sutures are removed when the baby is considered full term. If
necessary,the sutures can be removed earlier
 Cervical cerclage might be recommended if she is less than 24 weeks pregnant
& she had a history of premature birth and ultrasound shows that cervix is
opening or that the cervical length is less than 25mm .