Preterm labour and birth

Question 1

What is the preterm labour?

Answer 1

Regular uterine contractions with cervical effacement, dilation, or both before 37 weeks gestation

Question 2

What is preterm birth?

Answer 2

Live birth between 20 0/7 weeks and 36 6/7 weeks of gestation
(WHO subcategories)
Extremely preterm (< 28 weeks)
Very preterm (28 to < 32 weeks)
Moderate to late preterm (32 to < 37 weeks)

Question 3

What are the risk factors of preterm labour/birth?

Answer 3

(High risk factors) 
History of preterm birth
Cervical insufficiency
Multiple gestation
(Low risk factors) 
Infections 
Polyhydramnios
Malaria
Hypertensive pregnancy disorders 
Diabetes mellitus, gestational diabetes
(Lifestyle / Environmental factors) 
Smoking
Substance use (e.g., alcohol or drugs)
Maternal or fetal stress
Maternal age (< 18 years, > 40 years)

Question 4

What are the clinical features of preterm labour/birth?

Answer 4

Regular uterine contractions and associated symptoms of labor
Cervical dilation ≥ 3 cm, effacement, or both
Premature rupture of membranes

Question 5

How is preterm labour/birth diagnosed?

Answer 5

Clinical diagnosis
(Supportive tests) Transvaginal cervical ultrasound (for diagnosis of short cervix)
Cervicovaginal fetal fibronectin detection test (+ve suggests preterm labour)

Question 6

What is the treatment for preterm labour/birth?

Answer 6

Single course of antenatal steroids (IM betamethasone  / IM dexamethasone) (Improves fetal lung maturity + surfactant) 
Tocolysis ( beta-adrenergic agonists (Ritodrine, Terbutaline) / NSAIDs / Calcium channel blockers / Magnesium sulfate) administration of tocolytics to inhibit uterine contractions and prolong pregnancy
Fetal neuroprotection (Magnesium sulfate)

Question 7

What are the complications of preterm labour/birth?

Answer 7

Neonatal respiratory distress syndrome (RDS)
Bronchopulmonary dysplasia (BPD)
Patent ductus arteriosus (PDA)
Retinopathy of prematurity (ROP)
Necrotizing enterocolitis (NEC)

Question 8

How can preterm labour/birth be prevented?

Answer 8

Avoid modifiable risk factors
managed cervical insufficiency (inability of the uterine cervix to retain a pregnancy in the second trimester)
Vaginal progesterone supplementation