7.4. Complications of Pregnancy - Preterm Labour

Question 1

What is Preterm Labour?

Answer 1

The Onset of Labour before 37 completed weeks Gestation

Note - 259 days

Question 2

What are the Categories of Preterm Labour?

Answer 2

1. Mildly Preterm Labour - 32-36 Weeks
2. Very Preterm Labour - 28-32 Weeks
3. Extremely Preterm Labour - 24-28 Weeks

Question 3

What are the methods by which Preterm Labour happens?

Answer 3

1. Spontaneous

2. Induced (Iatrogenic)

Question 4

What is the Incidence of Preterm Labour in:

1. Singletons?
2. Multiple Pregnancy?

Answer 4

1. 5-7%

2. 30-40%

Question 5

What are the Predisposing Foctors of Preterm Labour?

Answer 5

1. Multiple Pregnancy
2. Polyhydramnios
3. Antepartum Haemorrhage
4. Pre-Eclampsia
5. Infection (e.g. UTI)
6. Prelabour Premature Rupture of the Membranes
   Note - The Majority are Idiopathic (No cause)

Question 6

How is Preterm Labour Diagnosed?

Answer 6

Contractions with Evidence of Cervical Change on Vaginal Examination
Note - Consider possible cause - Abruption / Infection

Question 7

What is the Management of Preterm Labour?

Answer 7

All cases considered Viable:

1. Consider Tocolysis to allow Steroids / Transfer
2. Steroids unless contraindicated
3. Transfer to unit with Neonatal Intensive Care Unit (NICU) Facilities
4. Aim for Vaginal Delivery

Question 8

What is the prognosis for an Extremely Preterm Labour?

Answer 8

Generally Regarded as Very Poor:
1. <24 weeks - 6% - 65% of survivors with severe Disability
2. 24 weeks - 26% - 38% of survivors with severe Disability
3. 25 weeks - 43% - 31% of survivors with severe Disability
4. 26 weeks - 48% - 26% of survivors with severe Disability
5. 27 weeks - 73%
6. 28 weeks - 84%
Note - Descisions made in Discussion with Parents and Neonatologists

Question 9

What Neonatal Morbidity results from Prematurity?

Answer 9

1. Respiratory Distress Syndrome
2. Intravascular Haemorrhage
3. Cerebral Palsy
4. Nutrition
5. Temperature Control
6. Jaundice
7. Infections
8. Hearing / Visual Impairment