TABLE OF CONTENTS

• DEFINITION

• RISK FACTORS

• ETIOPATHOGENESIS

• DIAGNOSIS

• TYPES

• PREDICTION

• ARREST

• MANAGEMENT

DEFINITION

Preterm labor is defined as one where the labor starts before the 37th

completed week, counting from the first day of the last menstrual period.

RISK FACTORS

A previous H/O preterm labor: Most consistent risk factor

Pre-eclampsia

Multiple pregnancy

APH

PROM

Polyhydramnios

Genital/ urinary tract infection

Low socio-economic status

Maternal smoking.

ETIOPATHOGENESIS

DIAGNOSIS

It is better to overdiagnose preterm labor than to ignore the possibility of its presence.

Diagnostic points are:

1. Regular uterine contractions (at least 1 in every 10 minute)

2. Cervical dilatation (> 2 cm)

3. Cervical effacement (80%)

4. Length of the cervix (measured by TVS) < 2.5 cm and funneling of the internal os.

TYPES

• EARLY preterm labour: Other diagnostic criteria + cervical dilatation 1-3 cm

• ADVANCED preterm labour: Other diagnostic criteria + cervical dilatation >3 cm

• THREATENED preterm labour: Cervical length of <2.5 cm (measured by TVS) + No uterine contractions.

PREDICTORS OF PRETERM LABOUR

• Fetal fibronectin:

Fibronectin is a glycoprotein that binds the fetal membranes to the decidua.

Normally it is found in the cervicovaginal discharge before 22 weeks and again after 37 weeks of pregnancy.

Presence of fibronectin in the cervicovaginal discharge between 24 and 34 weeks is a predictor of preterm labor.

When the test is negative it reassures that delivery will not occur within next 7 days.

• Cervical length as measured by TVS: <2.5 cm by 24 weeks.

MEASURES TO ARREST PRETERM LABOUR

• Bed rest in left lateral position

• Adequate hydration

• Glucocorticoids

• Prophylactic cervical circlage (in some cases)

• Tocolytics*.

* Note: Tocolytics should preferably be avoided as there is no clear benefit (RCOG–2002).

TOCOLYTICS

GLUCOCORTICOIDS

• Maternal administration of glucocorticoids is advocated where the pregnancy is <34 weeks.

• This helps in fetal lung maturation so that the incidence of RDS, IVH and NEC are minimized.

• This is beneficial when the delivery is delayed beyond 48 hours of the first dose. Benefit persists as long as 18 days.

• Either betamethasone 12 mg IM 24 hours apart for 2 doses or dexamethasone 6 mg IM every 12 hours for 4 doses is given.

• Betamethasone is the steroid of choice (RCOG – 2004).

MANAGEMENT OF PRETERM LABOUR

FIRST STAGE SECOND STAGE

Bed rest Ensure adequate fetal oxygenation

(by giving oxygen by mask to mother) Epidural analgesia Labor should be carefully monitored

preferably by through continuous CTG LSCS only in case of obstetric reasons

only.

Birth should be gentle and slow Episiotomy to reduce head

compression Clamping the cord immediately after

birth (to reduce hyperbilirubinemia) To shift the baby to NICU.

Thank you….

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