Premature Labour

Question 1

Premature Labour Definition

Answer 1

• Presence of contractions of sufficient strength and frequency to effect progressive effacement and dilation of the cervix before 37 weeks gestation
• Infants born have significant morbidity
• Early recognition allows early prevention

Question 2

Premature Labour Epidemiology

Answer 2

Very premature births rare but account for 51% of infant deaths

Question 3

Premature Labour RFs

Answer 3

• 30% are unexplained and spontaneous
• 30% multiple pregancies
• Infection, PPROM, antepartum haemorrhage, cervical incompetence, congenital uterine abnormalties
• Low socio-economic status and PHx are biggest risk factors
• 25% are elective because of maternal or foetal factors (e.g. pre-eclampsia or extreme IUGR)

Question 4

Premature Labour Diagnosis

Answer 4

-Many with painful contractions will be experiencing Braxton Hicks contraction and 60% will not have delivered within 48hrs
History
-Length of time, interval between contraction, bleeding or fluid loss, previous obstetric history, current pregnancy history, smoking
-Speculum examination may reveal dilation of cervix, and/or amniotic fluid leakage
-Digital examination should not be performed if suspected membrane rupture
-If membranes have not ruptured, should be performed as it is best way of assessing onset of premature labour

Question 5

Premature Labour Ix

Answer 5

-Women with intact membranes who are <29+6 weeks of gestation do not require further investigations to confirm
For women with intact membranes who are >30 weeks of gestation
-Transvaginal ultrasound measurement of cervical length
-Foetal fibronectin is cheap alternative when ultrasound is not available
-Vaginal swab to allow future treatment

Question 6

Premature Labour Management

Answer 6

-Transfer to available facility
-Alert emergency paediatric team
Tocolysis
-May be considered if otherwise uncomplicated pregnancy
-Very preterm labour, needing transfer to hospital, those who have not completed full course of corticosteroids
-Do not use in PPROM
-If used, use Nifedipine
-Do not use multiple tocolytics
Corticosteroids
-If between 24 and 37 weeks
-24mg of betamethasone over 24-48 hour period
Magnesium sulfate (for when in labour)
-Reduces risk of cerebral palsy
-Between 24 and 29 weeks and expected to deliver within 24 hours
Emergency cervical cerclage
-Dilated and exposed enraptured foetal membranes
-Contraindicated in infection, bleeding, any signs of contraction
Delivery
-If cephalic; vaginal, if breech; C-section