Preterm labor and

delivery
 Introduction
 Labor and delivery between 22 – 36+6 weeks
 Can be the leading cause of perinatal morbidity and
mortality
 Survival rates have increased and
morbidity has decreased because of technologic advances

Term LaborPreterm Labor

Worldwide an estimated 11.1% of all
livebirths in 2010 were born preterm (14.9
million babies were born before 37 weeks
of gestation), both in developed and in
developing countries.
 WHO Report "Born Too Soon: the global action
report on preterm birth". Estimated distribution
of causes of 3.1 million neonatal deaths in 193
countries in 2010.
 Survival by gestational age among
live-born resuscitated infants

PRETERM
LABOR 
Most mortality
and morbidity is
experienced by
babies born
before 34 weeks

In: Creasy, Resnik . Maternal – Fetal Medicine, 2009

Preterm birth can be further sub-divided based on gestational age: extremely preterm
(<28 weeks), very preterm (28 - <32 weeks) and moderate preterm (32 - <37
completed weeks of gestation)
Premature rupture of the membranes
(PROM) is defined as amniorrhexis
(spontaneous rupture of membranes)
prior to the onset of labor at any stage
of gestation.
Major Risks of Preterm Delivery
The Preterm Delivery Syndrome
Uterine Cervical
Overdistension Disease

Vascular Hormonal

Immunological
Infection
Unknown

© VR RR MM
Risk Factors(1)
 Previous preterm delivery
 Low socioeconomic status
 Maternal age <18 years or >40 years
 Multiple gestation
 Maternal history of one or more spontaneous second-trimester
abortions
 Maternal complications (medical or obstetric)
 Lack of prenatal care
Risk Factors(2)
 Uterine causes
 Myoma (particularly submucosal)
 Uterine septum
 Bicornuate uterus
 Cervical incompetence
 Abnormal placentation
Risk Factors(3)
 Infectious causes
 Chorioamnionitis
 Bacterialvaginosis
 Asymptomatic bacteriuria
 Acute pyelonephritis
 Cervical/vaginal colonization
 Fetal causes
 Intrauterine fetal death
 Intrauterine growth retardation
 Congenital anomalies
Treatment
 Tocolytic therapy
 Terbutaline Beta2-adrenergic receptor agonist
sympathomimetic; decreases free intracellular
calcium ions
 Nifedipine Calcium channel blocker
 Prostaglandin synthetase inhibitors:
indomethacin, administered both orally and
rectally
Treatment
Treatment

 Tocolytic therapy may offer some short-term

benefit in the management of preterm labor.
 A delay in delivery can be used to administer
corticosteroids to enhance pulmonary maturity
and reduce the severity of fetal respiratory
distress syndrome.
Treatment
 Antibiotic Therapy
 women who received antibiotics sustained
pregnancy twice as long as those who did not
receive antibiotics
 had a lower incidence of clinical amnionitis.
 poor fetal outcome (death, respiratory
distress, sepsis, intraventricular hemorrhage
or necrotizing colitis) occurred less frequently
in women receiving antibiotics
Treatment
With modern neonatal care, the lower limit of
potential viability is 22 weeks or 500g, although these
limits vary with the expertise of the neonatal intensive
care unit.