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Premature Labor

Dr. Gehanath Baral


MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of Nepal
Visiting Professor: CTGU
5th April, 2007

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Definition
 Start of labor before 37 weeks of
gestation.
 Incidence:
 Preterm =10%
 Term =80%
 Post term=10%

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Causes: Maternal

Maternal:
1. Pregnancy complication:-PET, APH, PROM, Polyhyd
ramnios

2. Uterine anomaly:- Cx incompetence, Unicornuate u


terus, Uterine septum, Hypoplastic uterus, Fibroid

3. Febrile infection/Chronic disease

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Causes: Fetal/placental

Fetal: Others:
1. Multiple pregnancy 1. Idiopathic
2. IUFD 2. Premature induction
3. Malformed fetus 3. Past abortion/ preterm
Placental: del.
1. Abruption/Previa 4. Smoking
2. Thrombosis/Infarction

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Diagnosis
 All symptoms and signs Signs:
of labor  Contraction
Symptoms:  Dilatation>2cm
 28-36 weeks of  Effacement
gestation  PROM
 Show

 Bearing down pain

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Principle of Management

1. Manage treatable causative factors


2. Give tocolytics
3. Enhance fetal maturity
4. Labor/Fetal monitoring: High rate of fetal distress
5. Conduct safe delivery
6. Prepare for premature neonatal care
7. Stabilize maternal condition:
1. Intrapartum
2. Postpartum

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Management:1

1. Control febrile episode


2. Treat infection
3. Prophylactic antibiotics:
1. Penicillin/Cephalosporin
2. Metronidazole
4. Control hypertension

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Management:2
1. Bed rest
2. Hydration
3. B2-Agonist:
1. Salbutamol=2-4mg x 3 P/O
2. Terbutalin=0.25mg q3-4hrs S/C
3. Ritodrine=50micg/min+@50micg/min q10min
4. Isoxsuprine=10mg x 3 P/O; 40mg infusion@12-15drops/mi
n
4. Ca++channel blockers:
1. Nifedipine= 5-10mg q6-8hrs S/L
5. PGInhibitors:
1. Indomethacin=50mg25mg q6hrs x 48hrs P/O
6. MgSO4=5gm infusion in 30min1-2gm/hr

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Management:3

1. Enhance fetal lung maturity


2. To prevent:
1. RDS (respiratory distress syndrome)
2. IVH (intraventricular hemorrhage)
3. Drug:
1. Betamethasone or Dexamethasone = 24mg in 2-3 divi
ded doses within 24hrs
2. Time:
 If <34weeks of gestation
 Up to 36weeks for multiple fetus/diabetic mother
3. If labor can be postponed for at least 48-72hrs
4. Repeat after a week

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Contraindication to Tocolysis
 IUFD  Uncontrolled medical
 Fetal distress disease:
 DM
 Chorioamnionitis
 HTN
 Placenta previa/abruption  Cardiac disease
 Abnormal baby  Thyroid disorder
 Active labor  Unstable maternal
 Rupture of membrane condition

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Vaginal Delivery

1. Slow and gentle


 To prevent rapid compression/decompression
2. Avoid rupturing membrane
 To retain cushion effect of amniotic fluid
3. Apply episiotomy
 To minimise head compression
4. Apply forceps
 To prevent prolonged 2nd stage
 To prevent sudden compression/decompression
5. Early cord clamp
 To prevent hypervolemia

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Operative delivery

1. Vacuum- Contraindicated
2. Forceps-
 All cephalic presentation
 After coming head of breech
3. CS-
 Breech:
1. Head>Trunk
2. Risk of cord prolapse
3. Head entrapment by incompletely dilated cx
 Multiple pregnancy

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Complication
 High morbidity
 High mortality
 Adverse effect of medication
 Maternal DM deteriorated by glucocorticoids
 Occult chorioamnionitis flared up by:
 Glucocorticoids
 Tocolytics
 Costly neonatal treatment
 Neonatal intensive care
 Surfactant

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