1. Preterm Labour
Dr. Madhavi Karki

2. 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.

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

4. 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

5. 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

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

7. 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

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

9. 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

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

11. 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