preterm labour

Question 1

what is preterm labour

Answer 1

Pre-term labour is the onset of regular uterine contractions and cervical changes occurring before 37 weeks gestation.
Preterm birth is the delivery of a baby after 20 weeks gestation but before 37 weeks gestation.

Question 2

what is PROM

Answer 2

Premature rupture of membranes (PROM) is rupture of membranes at least one hour before the onset of contractions.

Question 3

what is prolonged PROM

Answer 3

Prolonged premature rupture of membranes is the rupture of membranes more than 24 hours before the onset of labour.

Question 4

what is Pre-term premature rupture of membranes (PPROM)

Answer 4

Pre-term premature rupture of membranes (PPROM) is early rupture of the membranes before 37 weeks gestation.

Question 5

foetal fibronectin test (fFN test).

Answer 5

A screening test which is sometimes used to assess the risk of preterm delivery after the onset of pre-term labour is the foetal fibronectin test (fFN test). A negative fFN test means that there is likely to be low risk of delivery occurring within the next 7-14 days.

Question 6

risk facotrs
isk factors
Conditions associated with pre-term labour and delivery:

Conditions which may cause “overstretching of the uterus”

Multiple pregnancy (commonly due to assisted conception) and polyhydramnios
Conditions where foetus is at risk

Pre-eclampsia, intrauterine growth restriction, placental abruption etc.
Problems with the uterus or cervix

Fibroids, congenital uterine malformation, short or weak cervix, previous uterine or cervical surgery
Infection including chorioamnionitis, maternal or neonatal sepsis, bacterial vaginosis, trichomoniasis, Group B Streptococcus, sexually transmitted infections (e.g. Chlamydia) and recurrent urinary tract infections

Maternal co-morbidity (for example: Hypertension, diabetes, renal failure, thyroid disease etc.

Question 7

managemnet of preterm labour

Answer 7

Corticosteroids should be given to accelerate foetal lung maturation (betamethasone or dexamethasone).

Intravenous antibiotics should be given if there is increased risk of infection (evidence of Group B Streptococcus (GBS) in current or previous pregnancy, presence of maternal fever).

Penicillin is the antibiotic of choice if there is no allergy.

Tocolytic agents may be considered to buy time for administration of corticosteroids, but risk of side effects and benefits should be weighed up.

Nifedipine is the recommended first-line tocolytic agent.

consider taking to neonatal unit