PRETEM LABOUR

BY F. KAPALAMULA
30 AUGUST 2023
OBJECTIVES

• Define preterm labour

• Describe the aetiology of preterm labour
• Explain how preterm labour can be prevented
• Outline the assessment of a client with
preterm labour
• Explain the management of a woman with
preterm labour
DEFINITION

• Contractions that cause cervical dilatation at less than 37

weeks gestation.

• Labour occurring from 28 weeks (in developed countries

its 20 weeks) gestation to the end of the 36th week
DEFINITION CONT

• It complicates 10-12% of all pregnancies

• Associated with significant neonatal mortality and

morbidity especially at 24-34 weeks.
AETIOLOGY

• 40% unknown
• Multiple gestation
• Cervical incompetence
• Maternal age and parity
• Premature rupture of membranes
• Rhesus incompartibility
AETIOLOGY CONT…

• Idiopathic –in parous women there is often a history of

previous preterm delivery
• Infection- toxins have a stimulatory effect on the uterus or
may weaken the membranes
• Medical conditions such as anaemia, cardiac, renal, diabetes
AETIOLOGY CT

• Febrile conditions, for example malaria

• APH- abruptio stimulates uterine activity and repeated
hemorrhages may cause weakening of the membranes
• Over distention of uterus (increased intra uterine
pressure).
AETIOLOGY CT

• Malformations of the uterus

• Cervical abnormality
• Fetal malformations
• Elective preterm delivery as a result of
medical and obstetric conditions and / or
miscalculation of dates
OTHER ASSOCIATED FACTORS

• Stress
• Heavy work
• Poor antenatal attendance
• Trauma
• Toxins – smoke, alcohol and drugs
CAUSES OF PRETERM LABOUR
 PREVENTION OF PRETERM
LABOUR

• Identify women at risk based on the causative factors

• Educate clients at risk on prevention and early

detection of preterm of preterm labour

• Investigate possible causes in at risk women, for

example obtaining vaginal or periurethral swab to rule
out infection
PREVENTION OF PRETERM
LABOUR

• Provide treatment for any pathology, for example infection

or anaemia
• If previous preterm delivery and current singletone
gestation treat with Homorin 200mg IM every week 16
weeks-36 weeks if available.

• Mechanical factors are managed surgically – insertion of

shirodkar suture.
CLINICAL MANIFESTATIONS

• Menstrual like cramps

• Backache
• Urinary frequency
• Spotting
• Increased vaginal discharge
• Diarrhoea
CLINICAL MANIFESTATIONS
CONT

• There is a progressive increase in strength and interval

between contractions at rest

• NO DIGITAL VAGINAL EXAMINATION – only do a

sterile speculum exam to observe the cervical os and state
of membranes

• USS will help in assessing fetal maturity

MANAGEMENT OF PRETERM
LABOUR

• Admit the woman to hospital

• Nurse her in semi prone and a comfortable position
• Monitor fetal and maternal condition regularly
depending on the condition
• Investigate possible causes – urine tests, FBC,MPS.
MANAGEMENT CT

• Explain to the client the plan for management

• If gestation is 36 weeks or more, labour will

probably be allowed to continue as most babies
of this age make good progress

• Below 36 weeks, conservative management with

tocolytic drugs may be used if both mother and
fetus are in good condition, with no signs of
current vaginal bleeding, ruptured membranes or
eclampsia
CONSERVATIVE MANAGEMENT

• Patient must be on bed rest

• Magnesium Sulphate may also be used (SAME REGIMEN AS
SEVERE PREECLAMPSIA) until when contractions are less
than 1:10mins
• OR Nifedipine (Immediate release) 20mg loading dose then
10mg orally after 30minutes if still contracting after
30minutes you give 10mgs q2h(hold if maternal BP>90/50
mmHg
• When used if labour persists, may cause PPH
MANAGEMENT CONT

• Terbutaline 0.25mg SC every 20 min maximum 3hrs.Stop if

maternal pulse is more than 120beats per minute

• Indomethacine 50-100mgs loading dose

then 25-50mg PO every 6 hours x 48 hours (Only if more
than 32 weeks)
MANAGEMENT CONT

• Dexamethasone 6mg IM every 12 hourly

x48 hours
• OR
• Dexamethasone 12 mg every 24 hours x
48 hrs
Tocolytic drug contraindication Maternal side Fetal/neonatal side
effects effects
Nifedipine immediate Cardiac disease Flushing, headache, Sudden fetal death,
release 20mg load Use withcaution with dizziness, nausea, fetal distress
then 10mg PO if still renal disease transiet hypotension,
contracting after 30 transiet tachycardia,
minutes and 10mg palpitations
q2h (hold if maternal
BP less 90/50)

Indomethacin 50- Significant renal or Nausea, heart burn Constriction of

100mg load then 25- hepatic impairement dactus arteriosus,
50mg PO every 6hrs pulmonary
for 48hrs (only if less hypotension,
than 32 weeks) oligohydramnious,
hyperbilirubinemia

sabultamol No longer used

MANAGEMENT CONT
OR
• Betamethasone 6 – 12 mgs IM OD for 24 hrs may be
administered to accelerate fetal production of pulmonary
surfactant and lung maturity if the period of gestation is between
24 -34 weeks

• Monitor side effects of drugs

• Strict fluid balance is essential

MANAGEMENT CONT

• Monitor for liquor and show

• Provide reassurance to the woman

• When labour is controlled discharge the client and advise on

preventive measures

• Give work leave if working

PROGRESSIVE LABOUR
MANAGEMENT

• If the dilatation reaches 4 cm or more or

membranes rupture it is unlikely that labour will
be arrested
• Stop tocolytic drugs
• Provide usual management of labour and delivery
• Preserve membranes to prevent infection
MANAGEMENT CONT
• Avoid use of narcotic analgesics

• Do VE once the membranes rupture to r/o cord prolapse

• Prepare for the delivery - adequate resuscitation equipment

and in working order

• Monitor the mother carefully since labour may progress

rapidly
SECOND STAGE OF LABOUR
MGT

• The infant is at risk of intracranial hemorrhage because of poor

bone development

• Delivery should be conducted gently and smoothly

• Vacuum extraction should be avoided

• Do an episiotomy when the vulval ring begins to distend

MANAGEMENT CONT

• Provide immediate care to the newborn

• Give vitamin k 0.5 mgs – 1 mg IM to lessen
any risk of hemorrhage
• Show the baby to the mother and transfer to
the neonatal unit
QUESTIONS?
ASANTE!