Preterm labour

Definition Investigations

Onset of labour occurring between 24+0/40 to 36+6/40 Test Findings

weeks of gestation. CTG Presence of foetal heartbeat
Tocography >1 contraction every 10 mins
Preterm: 34 36+6 weeks gestation Transvaginal U/S Significant if cervix <2cm long
+ VE
Very preterm: 28 33+6 weeks gestation Cervico-vaginal If positive:
swab for foetal 20% chance will deliver in next
Extremely preterm: <28 weeks gestation
fibronectin 10 days
If negative:
97 99% will not delivery
Epidemiology prematurely
FBE Hb in APH
Occurs in up to 10% of babies born in WBC in infection
Australia High Look for GBS
<1% are extremely preterm (<28/40 weeks) vaginal/rectal Amnisure to test is
swab membranes have ruptured
Majority of preterm birth is due to iatrogenic
Kleihauer test To look for presence of foetal cells
induction for maternal/foetal cx e.g. pre-
in maternal circulation used to
eclampsia, IUGR calculate how much anti-D to give
Rh- mothers to prevent iso-
Risk factors/Aetiology
immunisation
Maternal Foetal
PROM Multiple pregnancy Prevention
Uterine abnormalities Foetal abnormalities
Infection (e.g. Polyhydramnios 1. Address risk factors
chorioamnionitis, GBS) Diet & lifestyle limit:
Cervical Indications for o Smoking
incompetence/short premature induction o Alcohol
cervix <2cm FGR o Illicit drug use
Foetal distress Having children at a healthy age (22 40)
Congenital >12 18 months between pregnancies
abnormalities
Hx of preterm labour
2. Treat & manage infections pre-pregnancy
(4x risk)
Social factors (smoking, Asymptomatic bacteuria MSU at first
alcohol, recreational antenatal checks
drug abuse, poor diet, Bacterial vaginosis, GBS, STI needs to be
coffee intake) tested for

3. Need for cervical suture

Signs & symptoms
Uterine contractions (>1 in 10 minutes less
likely to be Braxton-Hicks contractions)
P-PROM pooling of liquor on spec exam
Cervical length <2cm
+/- Dilatation of cervix
+/- Non-specific lower abdo or back pain
+/- PV bleed (assoc with APH due to placental
abruption)
+/- Maternal/foetal tachycardia
If there is hx of shortened cervix, or U/S
indications
Suture is put into cervix to prevent dilatation
before ripening
4. Consider the role of vaginal progesterone
To balance out the oestrogen:progesterone
ratio to promote myometrial quiescence &
delay labour
Management
STATIN
Steroids (if <34 weeks) 2 x doses of betamethasone
(celestone) 11.4mg IM, 24 hrs apart
Foetal lung maturation - ARDS
Gut closure promotes sphincter formation
Renal differentiation - glomerular units
HgB stimulates change from HbF to adult Hb
Transfer to Tertiary centre with access to neonatal
resuscitation facilities & blood transfusion
Antibiotics (if pPROM)
Pre-partum: Erythromycin 250mg PO, QID
Intra-partum
o Benpen 3g IV loading dose, then 1.8g
IV 4hrly until delivery
o If hypersensitive: Cephazolin 2g IV
8hrly until delivery
o Anaphylactic: clindamycin 600mg IV,
8hrly until delivery
pPROM without chorioamnionitis
o Amoxy/ampicillin 2g IV, 6hrly for
48hrs followed by amoxycillin 250mg
PO, 8hrly for 7/7
PLUS
o Erythromycin 250mg PO, 6hrly for 7/7
Tocolysis (to give time to administer steroids)
Nifedipine (CCB)
o Peripheral acting Ca2+ antagonist that
prevents uterine contraction
Terbutaline (-antagonist)
o Inhibits -receptors, SNS
stimulation of uterine myometrium
relaxation
o Can also be used to maternal HR
Intrapartum care consider vaginal vs C-section
delivery + continuous CTG
Neuroprotection (if <30/40) maternal IV MgSO4
infusion