Pre Term Labour

Preterm Labour
Definition:-
When the labour starts after 28 weeks but
before completion of 37 weeks of period of
gestation
[Preterm birth is a leading & major cause of
neonatal morbidity and mortality after
congenital anomalies]

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 Preterm Labour
Incidence:- 5 to 10%

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 Preterm Labour- Etiology
• History
– Past H/O Preterm labour
– ART
– Infections
• Urinary
• Genital
– Smoking
– Poor socio-economic status
 Preterm Labour- Etiology
Maternal factors

– Pre-eclampsia
– APH
– PROM
• Overdistension of Uterus
– Polyhydramnios
– Multiple Pregnancy
 Preterm Labour- Etiology
Maternal factors

• Uterine Anomalies
– Short Cervix
– Structural anomalies of uterus
• Medical/ Surgical Conditions
– Fever
– Systemic Infections
– Surgery
 Preterm Labour- Etiology
Maternal factors
• Uro-Genital Infections
• Chronic Disorders
– HT/DM/Heart disease/Anemia
 Preterm Labour- Etiology
Iatrogenic factors
• DM
• Pre-Eclampsia
• Wrong Dates
• IUGR
• APH
Preterm Labour- Etiology
Idiopathic
 Pathology - Preterm Labour
• Not yet well understood
• Silent infection of genital organs produces
inflammatory mediators [Cytokines –
Interlukines & Tumor necrosis factors] induces
production of Prostaglandins which initiates
uterine contractions

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 Diagnosis – Preterm Labour
1) Uterine contractions
Regular
1/10 min or more leading to progressive
cervical changes
2) Cervical effacement - > 80%
3) Cervical dilatation - > 2 cm
4) Vaginal Bleeding/ Discharge

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 Management
• Aim –
1) Decrease perinatal mortality and morbidity
2) Preservation of good health of the mother

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 Management contd…
The aim is achieved by -
1) Prevention of onset of preterm labour
2) Arrest of preterm labour
3) Careful monitoring and management of
labour
4) Proper neonatal care

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 Investigations
1) Hb, TLC and DLC
2) Urine R/E and culture/ ABST
3) Endo cervical swab culture and ABST
4) Blood sugar F/ PP & serum electrolytes
5) USG for cervical length and fetal well-being

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 Treatment
• Adequate bed rest [ hospitalisation/ sedation
& hydration]
• Good nutrition with supplements
• Avoid smoking
• Cervical encirclage and antibiotics

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 Treatment contd…
• Tocolysis –
Inj Ritrodrine hydrochloride 50 to 100 µg/ min IV drip
[max 350 µg / min till contractions ]
S/E Nausea, Vomiting, Tachycardia, Hypotention,
Cardiac arrhythmias & Pulmonary edema
(Other tocolytic agents – Isoxsuprine, Salbutamol, Mg
Sulf, Terbutaline, Nifedipine, Atosiban and Nitric
Oxide donor- GTN)

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 Treatment contd…
• If delivery is imminent and POG is < 34 weeks
then Surfactant induction by giving
– Inj Betamethasone 12 mg IM at 24 hour interval X
2 doses
– Inj Dexamethasone 6 mg IM X 12 hrly X 4 doses

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 Delivery – Preterm Labour
• Prevent birth asphyxia – avoid sedation, acceleration
of labour, rupture of membranes, rest in lateral
position, nutrition and hydration
• Prevent birth trauma – deliver by liberal episiotomy,
cut short 2nd stage by forceps application if indicated,
LSCS and clamp the cord immediately
• Good neonatology care

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