Preterm labour

Definition Investigations

Onset of labour occurring between 24+0/40 to 36+6/40 Test Findings
weeks of gestation. CTG Presence of foetal heartbeat
Tocography >1 contraction every 10 mins
Preterm: 34 – 36+6 weeks gestation Transvaginal U/S Significant if cervix <2cm long
+ VE
Very preterm: 28 – 33+6 weeks gestation Cervico-vaginal If positive:
swab for foetal  20% chance will deliver in next
Extremely preterm: <28 weeks gestation
fibronectin 10 days
If negative:
 97 – 99% will not delivery
Epidemiology prematurely
FBE  ↓Hb in APH
 Occurs in up to 10% of babies born in  ↑WBC in infection
Australia High  Look for GBS
 <1% are extremely preterm (<28/40 weeks) vaginal/rectal  Amnisure to test is
swab membranes have ruptured
 Majority of preterm birth is due to iatrogenic
Kleihauer test To look for presence of foetal cells
induction for maternal/foetal cx e.g. pre-
in maternal circulation – used to
eclampsia, IUGR calculate how much anti-D to give
Rh- mothers to prevent iso-
Risk factors/Aetiology
immunisation
Maternal Foetal
PROM Multiple pregnancy Prevention
Uterine abnormalities Foetal abnormalities
Infection (e.g. Polyhydramnios 1. Address risk factors
chorioamnionitis, GBS)  Diet & lifestyle – limit:
Cervical Indications for o Smoking
incompetence/short premature induction o Alcohol
cervix <2cm  FGR o Illicit drug use
 Foetal distress  Having children at a healthy age (22 – 40)
 Congenital  >12 – 18 months between pregnancies
abnormalities
Hx of preterm labour
2. Treat & manage infections pre-pregnancy
(4x ↑risk)
Social factors (smoking,  Asymptomatic bacteuria – MSU at first
alcohol, recreational antenatal checks
drug abuse, poor diet,  Bacterial vaginosis, GBS, STI – needs to be
coffee intake) tested for

3. Need for cervical suture
Signs & symptoms
 If there is hx of shortened cervix, or U/S
 Uterine contractions (>1 in 10 minutes less indications
likely to be Braxton-Hicks contractions)  Suture is put into cervix to prevent dilatation
 P-PROM – pooling of liquor on spec exam before ripening
 Cervical length <2cm
 +/- Dilatation of cervix 4. Consider the role of vaginal progesterone
 +/- Non-specific lower abdo or back pain  To balance out the oestrogen:progesterone
 +/- PV bleed (assoc with APH due to placental ratio to promote myometrial quiescence &
abruption) delay labour
 +/- Maternal/foetal tachycardia

8g Intrapartum care – consider vaginal vs C-section IV 4hrly until delivery delivery + continuous CTG o If hypersensitive: Cephazolin 2g IV 8hrly until delivery Neuroprotection (if <30/40) – maternal IV MgSO4 o Anaphylactic: clindamycin 600mg IV. 24 hrs apart PLUS o Erythromycin 250mg PO. ↓SNS Antibiotics (if pPROM) stimulation of uterine myometrium   Pre-partum: Erythromycin 250mg PO. QID ↑relaxation  Intra-partum o Can also be used to ↓maternal HR o Benpen 3g IV loading dose.Management  pPROM without chorioamnionitis o Amoxy/ampicillin 2g IV.4mg IM. then 1. 6hrly for STATIN 48hrs followed by amoxycillin 250mg Steroids (if <34 weeks) – 2 x doses of betamethasone PO.↓ARDS  Gut closure – promotes sphincter formation Tocolysis (to give time to administer steroids)  Renal differentiation . 8hrly for 7/7 (celestone) 11. 6hrly for 7/7  Foetal lung maturation . infusion 8hrly until delivery .↑glomerular units  Nifedipine (CCB)  HgB – stimulates change from HbF to adult Hb o Peripheral acting Ca2+ antagonist that Transfer to Tertiary centre with access to neonatal prevents uterine contraction resuscitation facilities & blood transfusion  Terbutaline (β-antagonist) o Inhibits β-receptors.