Preterm Labour Dr. Madhavi Karki

Definition : Preterm Labour is defined as one where the labour starts before 37th completed week , counting from the first day of the last menstrual period.

Complications in present pregnancy ETIOLOGY History Complications in present pregnancy Iatrogenic Idiopathic

Complications in present Pregnancy Previous history of induced/spontaneous abortion Asymptomatic bacteriuria/ recurrent UTI Smoking Low socio-economic status History Maternal Fetal Placental Complications in present Pregnancy Elective induction with wrong estimation of gestational age Iatrogenic

Pregnancy Complications Uterine anomalies Medical and Surgical Illness Pre-eclampsia Antepartum hemorrhage PROM Polyhydramnios Uterine anomalies Cervical incompetence Malformation of the uterus Medical and Surgical Illness Acute fever Acute pyelonephritis Acute appendicitis Chronic Diseases : HTN,Diabetes Genital Tract Infections: bacterial vaginosis

ETIOPATHOGENESIS Infection/inflammation of the genital organs leads to increase in cytokines Induces increased biosynthesis of prostaglandins and leukotrienes Preterm uterine contractions

DIAGNOSIS Regular uterine contractions with or without pain(at least one in every 10 mins Dilatation (>2cms) and effacement (80%) of the cervix Pelvic pressure, backache and/or vaginal discharge Note: it is better to over diagnose premature labour than to ignore the possibility of its presence

MANAGEMENT To arrest preterm labour Prevention Appropriate management of labour Effective neonatal care

1. Prevention: Identification of the risk factors Adequate rest Nutritional supplements Avoidance of smoking Encirclage operation Premature effacement of the cervix with irritable uterus : bed rest and tocolytic agents Be sure of gestational age before induction Selective continuation of complicated pregnancy

TO ARREST PRETERM LABOUR Absolute Bed Rest Adequate Sedation Adequate Hydration Tocolytic Agents

Place of Cesarean Section MANAGEMENT OF PRETERM LABOUR Patient is put to bed for prevention of PROM To ensure adequate fetal oxygenation by giving oxygen to mother Labour should be watched by intensive clinical/electronic monitoring First Stage The birth should be gentle and slow to avoid rapid compression and decompression of the head Liberal episiotomy should be given Tendency to delay is curtailed by low forceps Cord to be clamped and cut immediately Second Stage Preterm fetuses before 34th week with breech presentation are delivered by cesarean section Place of Cesarean Section