PRETERM LABOUR REPORT

So, for our disposition and future plans, primarily once we have
established that indeed our patient is in preterm labour and we have
admitted the patient for management as what was mentioned earlier, it is
important for us to have continuous fetal status monitoring as well as
monitoring of the progress of labour. The NICE guidelines suggests that
the woman and her family can have a choice of monitoring the fetal heart
rate either via: CTG or intermittent auscultation. According to still to the
NICE guidelines, there is an absence of evidence that using CTG
improves the outcomes of preterm labour for a woman compared with
intermittent auscultation. However, in the guidelines of the Philippine
Obstetrical and Gynecological Society, they stated that CTG should be
considered when regular fetal surveillance is required especially in the
cases of fetal tachycardia, which may be present as a late sign of
infection. Aside from this, we should also monitor the progress of labour.
Especially since we have administered already our corticosteroids and
out tocolytic agents. So primarily these are given to delay or prevent the
preterm delivery and to improve fetal prognosis.

We also advise bed rest and hydration to our patient while we are
monitoring her. This is in the attempt to reduce stress in pregnancy
which may help decrease the risk of preterm delivery. Although we
should not be advising strict bed rest. Because according to the ACOG,
there have been a number of randomized clinical trials assessing
bedrest may it be in the hospital or at home and even hydration to have
no demonstrated clinical benefits. It may actually pose risks to the
mother and the fetus, predisposing to thrombosis and osteoporosis.
Home management is an attractive alternative to hospital care for
women experiencing preterm labor. Discharging women with preterm
contractions without objective evidence of labor does not result in an
increased risk of preterm births. A randomized study of women after they
had received treatment comparing home care or hospital care did not
show significant difference between the two groups in mean gestational
age at delivery or mean birthweight. Thus, no evidence exists that
bedrest should be a standard component of prevention or treatment for
preterm labor. Home management is an alternative treatment to hospital
care for women with preterm birth.

Of course, part of risk reduction for further preterm labour, is to have

lifestyle modifications like having a balanced diet. We need to explain to
her the benefits of eating a balanced diet comprised of adequate
carbohydrate, protein, and fat to ensure a healthy mother and baby
during this period. As well as avoiding any strenuous exercises or
activities.

Perineal care should also be advised. Patient should thoroughly wash

the external genitalia, washing in the direction of perinium to rectum and
to dry the area thoroughly.

To continue our antibiotic therapy. And after which, based on the CPG
for the management of UTI in pregnancy, a repeat culture should be
done 1 to 2 weeks after completion of therapy, to confirm the eradication
of our bacteriuria and resolution of infection in our pregnant woman.

We should also advise the family about methods of family planning as

well. Since there are a lot of postpartum birth control methods, it is
important to discuss these one by one with the family and for them to
choose a plan of contraception that they feel comfortable with.

So in the scenario that our patient can be discharged after receiving

treatment, like what I’ve mentioned earlier…So provided that we have
done all the management necessary for this patient. Like our
Corticosteroids, Magnesium sulfate, Antimicrobials to address the
current infections, and Tocolysis, and after which preterm birth did not
occur following admission for threatened preterm labour, we should
coordinate the care and discharge planning with the family as well as the
associated hospitals in the event that this will happen again. This is from
the Queensland Clinical Guidelines on Maternity and Neonates
regarding preterm labour and birth. So before discharging our patient, it’s
important of course to check the stability of the vital signs, if there are
any signs of chorioamnionitis, the status of the membranes, if
contractions are infrequent or irregular as well as if there are any more
changes within the cervix, and of course a normal CTG result. We
should also inform the woman of signs and symptoms of possible
preterm labour again, particularly if there will be ruptured bag of water.
As well as to discuss with her the risk reduction measures for preterm
labour, like smoking cessation, lifestyle modifications involving of course
a balance diet, activity limitations, and stress management. Of course as
I’ve mentioned earlier, the treatment of the ongoing infections could also
reduce the risk of another preterm labour. Also, to remind the patient to
have regular check- ups if she plans to have subsequent pregnancies.

But in the event that after monitoring our patient for 24 hours, we see a
progress in her cervical dilation as well as increasing pain from the
labour, then as long as we have already administered the needed
prophylaxis to make sure that our baby is safe and can be delivered
prematurely, then I think it would be best to proceed with preterm birth
delivery.