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Premature Labour

From Mediwikis
Labour commencing before 37+0 week’s gestation
Premature infant on CPAP

Risk Factors

Infection:

  • Chorioamnionitis –bacterial infection of amnion and chorion
  • Funsitis – infection of cord
  • UTI
  • Trichomonas
  • Chlamydia
  • Bacterial Vaginosis
  • Group B Strep
  • Worldwide – malaria, HIV, mycoplasma

Cardiovascular:

  • Pre-eclampsia
  • Hypertension

Maternal (medical):

  • PMH of premature labour
  • PMH of induced abortion
  • Cervical trauma
  • Uterine abnormalities
  • Obstetric cholestasis

Maternal (social):

  • Poor nutrition
  • Smoking, coffee, alcohol, recreational drug use
  • Extremes of age
  • Extremes of BMI
  • Stress – physical or emotional
  • Domestic violence

Fetal:

  • Multiple pregnancy
  • Polyhydramnios
  • IUGR
  • Fetal distress
  • Congenital abnormalities

Diagnosis

History

  • Duration and frequency contractions, painful
  • Vaginal loss – Bleeding, leaking fluid (R.O.M.?), changes in discharge (infection?)
  • Urinary Symptoms. – Urinary Tract Infection
  • Pyrexial – Systemic illness, Infection risk for premature labour
  • Symptoms of Pre-eclampsia- headache, nausea, vomiting
  • Last sexual intercourse – Prostaglandins in semen may induce labour
  • Examination – to assess cervical dilatation and effacement
  • Symphyseal-fundal height – see if correlation with gestational age
  • Determine presenting part, can use USS to confirm

Examination

  • Vaginal examination – speculum (preferably not digital as this can increase chances of labour progressing), assess cervical dilatation and effacement, level of presenting part if clinically indicate
  • Assess frequency and strength of the contractions
  • USS to confirm presenting part
  • Continuous electronic fetal monitoring if >26 weeks gestation

Fetal Fibronectin Swab

  • A confirmatory test used to confirm preterm labour
  • Fetal fibronectin is a fetal protein and is released into the vagina in cases of preterm labour
fFN Sawb Result Probability birth within 10 days (%) How to manage
NEGATIVE 0.8 Discharge
POSITIVE 20.6 Treat

Contraindications:

  • Proven rupture of membranes
  • Vaginal bleeding
  • Cervical dilatation >3 cm
  • Cervical cerclage (suture in the cervix to strengthen it to prevent premature labour in high risk mothers)
  • Placenta praevia

Management

Aims:

  1. Prevent preterm premature rupture of membranes (PPROM)
  2. Prevent preterm birth
  3. Postpone delivery to allow time for steroid induced lung maturation

>35wks gestation – allow labour to proceed <34wks gestation – suppress uterine activity (tocolysis). Induce lung maturation (steroids)
Tocolysis – inhibits uterine contractions.
Delay pre-term delivery, do not prevent it and should not be used for more than 24 hours. Allows time for steroids to work and get mother and baby to a SCBU. Nifedipine or atosiban, an oxitocin receptor antagonist.

Indications for Tocolysis:

  • 24-33+6wks gestation
  • <3 cm dilatation
  • Normal fetal heart rate
  • Positive fFN sweep

Steroids – used to mature lungs, typically Betamethasone is used. 12 mg IM repeated 24hrs later

Antibiotics

Contact neonatologist