diagnosis and management of preterm labour

Diagnosis and Management of Preterm Labor

prof. maysoon sharief

THE OBJECTIVES

_ Definition _Incidence _ Etiology _ Clinical features _ Management _ Neonatal complications
StatenIsland Universiaty Hospital

DEFINITION

Preterm labour is labour occurring before 37 completed weeks gestation( 24-37). Incidence:- 7 - 12% of labours are preterm. TYPES : according to gestational periods 1- mildly preterm birth (32- 37) weeks. 2- Very preterm birth (28- 31) weeks. 3- Extremely preterm birth ( 24- 27 ) weeks.

Aetiology

Idiopathic is 75% Local infection(vaginosis) 10-20%. Systemic infection like pyelonephritis. Placental abnormalities like placental abruption ,placental insufficiency. Fetal pathology. Uterine over distention( polyhydramnios, multiple pregnancy ,cervical incompetence). Maternal:- social class, weight, occupation.

Neonatal outcome after preterm labour

1- Respiratory distress syndrome(RDS). 2-Intraventicular haemorrhge. 3- Failure for growth. 5- Hypothermia 6-Hypoglycemia. 7- Visual and auditory impairment.
StatenIsland Universiaty Hospital

DIGNOSIS

The identification of patients at risk. The detection of early warning signs of preterm labour. The diagnosis of established preterm labour.

PATIENT AT RISK

1-Maternal age :less than 20 ,more than 40. 2-maternal over weight and under weight. 3-smoking. 4-low social class. 5-previous preterm labour or late abortion. 6-multiple pregnancy ,uterine abnormalities like septate uterus 1

Warning symptoms of preterm labour

Menstrual like cramps constant in nature Low dull backache Pelvic pressure(feels like the baby is pushing down) Increase or change in vaginal discharge(may be mucous,bloody)

Management of patients at risk

1- Antenatal education for high risk group about preterm labour. 2-Treatment of bacterial vaginosis . 3-Limitation of physical activity. 4 - Serial us examination for cervical length. 5- Cervical cerclage. 6- Progesterone ( inhibit myometrial contractility)

Diagnosis of established preterm labour

Clinical features: history: regular contraction ,backache,may or may not vaginal discharge or bleeding, decrease fetal movement. signs: 1- tachycardia, uterine contraction coming every 2-3 min and lasting for 1 min. 3 - cervical dilatation with ,effacement . 4- Fetal fibronectin testing (glycoprotein detected in vaginal secretions up to 20 wks).

Management of established preterm labour

Identification of patients who need delivery:- Maternal medical diseases( uncontrolled DM). Congenital fetal anomalies. Intrauterine growth retardation. Fetal lung maturation. Chorioamnionitis.
StatenIsland Universiaty Hospital

Management established preterm labour

1-Tocolytic agents:- for Suppression of uterine contractions . 2- Corticosteroid therapy: to improve lung maturation 3- Antibiotics : to reduce maternal fetal infection only in patients with group B streptococcus colonization.
StatenIsland Universiaty Hospital

Types of tocolytics agents

Magnesium sulfate. Beta-Sympathomimetics like salubutamol. Prostaglandin inhibitors like Indomethacin. Calcium channel blockers like nifedipine. Oxytocin-receptor antagonist like Atosiban. Ethanol. Progesterone .

Tocolytics

All these drugs seem to delay delivery 48 hours until corticosteroids action start. None is superior in efficacy. Corticosteroid therapy: 8mg/12hs for 2 days then repeated every one week. Start with IV tocolytic agent for 12- 24 hrs followed by oral tablet

SYMPATHOMIMETICS

- Treatment:- salbutamol 2.5 mg per500ml of 5% glucose water for 24 hrs. B - adrenergic agent side effect :-tachycardia, pulmonary odema, hyperglycemia . -containdication for beta-adrenergic agent like cardiac disease, hyperthyrodism, sickle cell anemia, DM ,chorioaminitis,eclampsia,multiple pregnancy ,severe obstetric bleeding .

Conduct of preterm delivery

1- Transfer a woman to an obstetric unit linked to neonatal intensive care unit prior to delivery. 2- Active management of labour with CTG monitoring. 3- C S is preferable for breech presentation. 4- There is NO evidence for elective forceps delivery to protect the fetal head and episiotomy is rarely required.
StatenIsland Universiaty Hospital

Thank you