2. 1. Definition
2. Risk Factors/Causes
3. Signs and symptoms
4. Test and diagnosis
5. Prevention
6. Management
3. Preterm labor occurs when regular contractions result
in the opening of your cervix after week 20 and before
week 37 of pregnancy. Preterm labor can result in
premature birth. The earlier premature birth happens, the
greater the health risks for your baby.
There are sub-categories of preterm birth, based on
gestational age:
extremely preterm (less than 28 weeks)
very preterm (28 to 32 weeks)
moderate to late preterm (32 to 37 weeks)
4. Genital tract infection: Group B Streptococci
Bacterial vaginosis
Chlamydia, Gonorrhea
Ante Partum Hemorrhage:
Over distended Uterus: Poly hydramnios
Multiple Pregnancy
Uterine Anomalies: Unicornuate, Bicornuate
fibroid uterus
5. Incompetent cervix
Acute fever and maternal illness
Premature rupture of membranes
Low socio economic status
Poor nutrition and anemia
Smoking and tobacco addiction
UTI
History of preterm labor
6. Change in type of vaginal discharge(watery
mucus or bloody)
Increase in amount of discharge
Pelvic or lower abdominal pressure
Dull backache
Mild abdominal cramps
Regular or frequent contractions or uterine
tightening , often painless
Ruptured membranes
7. Pelvic exam:
the health care provider might evaluate the
firmness and tenderness of the uterus and the
baby size and position. pelvic exam is to
determine if the cervix has begun to open
If the water hasn’t broken and the placenta is not
covering the cervix(placenta previa)
8. Ultrasound: an ultrasound might be used to
measure the length of the cervix and determine
a baby’s size, age, weight and position in the
uterus.
Might need to be monitored for a period of
time and then have another ultrasound to
measure any changes in the cervix, including
cervical length.
9. Uterine monitoring : the health care provider
might use a uterine monitor to measure the
duration and spacing of the contractions
Laboratory test:
Maturity amniocentesis
10. Cervical cerclage
prophylactic cerclage is used in women who
have a history of recurrent mid trimester losses
and who are diagnosed with cervical
insufficiency
prophylactic cerclage for women identified
during monographic examination to have a
short cervix.
“rescue” cerclage, done emergently when
cervical incompetence is recognized in women
with threatened preterm labor.
11. 2.Prophylaxis with Progestin Compounds
administration of progesterone to maintain
uterine quiescence may block preterm labor.
Basis: human parturition involves functional
progesterone withdrawal mediated by
decreased progesterone activity of
progesterone receptors
12. P/A- Regular uterine contractions
> 4 in 20 minutes or
>8 in 60 minutes,
with changes in cervix
Cervical effacement >80%
Cervical dilatation > 1 cm
13. -
Regular uterine contraction
Cervix > 1 cm & <3 cm dilated
Cervix > 80% effaced
14. If there is signs of
Chorioamnionitis
Congenital anomaly in fetus
Mother& fetus condition is not good
Allow labor and delivery.
15. But if
Fetal condition is not compromised
Maternal condition is good
No signs of chorioamnionitis
Membranes are intact
Then Expectant management includes
Bed rest in left lateral position
Antibiotic if infection is evident
Tocolysis
Corticosteroid if pregnancy < 34 weeks
16. When there are regular uterine contractions,
Cervix is <1cm dilated , length of cervix
<2.5cm on USG & GA <37 wks- Threatened PTL
Diagnosis is by
Clinical examination
USG
Detection of fetal fibronectin in cervical discharge
FFN in cervical discharge is usually absent
between wks , so if it is present it is predictor of
PTL
17. If FFN is negative in cervical discharge
indicates no delivery with in 7 days.
If threatened PTL is diagnosed by clinically,
USG & FFN then give tocolysis and
corticosteroid to woman.
19. Allow delivery if
-Cx is >4cm dilated
-Signs of chorioamnionitis
-Baby malformed-
Severe placental insufficiency
But if Cx is <4cm and none of the above is present give
tocolysis, corticosteroid & antibiotic if indicated
Aim – to give corticosteroid to prevent RDS &IVH in
baby & mother with fetus in utero can transfer to place
where neonatal care facility available
20. Betamethasone- 2 doses,12mg IM,24 hours
apart.
OR
Dexamethasone- 6mg IM 12 hOUrly total 4
doses
Corticosteroids are beneficial when delivery
occurs at least 48 hrs after 1st dose
21. Various tocolytic drugs which can be used are
Nefedipine
Betamimetics –Isoxsuprine
-Terbutaline
- Retrodine
- * Indomethacin
- * Mgso4
- * Nitroglycerine
22. It is the best first line tocolytic
It is a calcium channel blocker causes smooth
muscles relaxant
Doses-initial 20-30 mg orally followed by 10mg
4-6 hourly till uterine contraction stops f/b
10mg 8 hourly for about 1 week
Side effects: headache, hypotension, nausea
and flushing
23. It can be given iv or subcutaneous
For iv dissolve 5mg of terbutalinein 500 ml of
RL,each ml contains 100ug
Start with 5ug(.5ml)/min & increase the dose of
5ug every 10-20 minutes,till uterine contractions
stops.
Maximum dose 30ug/minute
Subcutaneous dose-.25mg every 3-4 hours for 12
hours
Maintenance dose 2.5 mg-5mg orally 4-6
times/day
24. Beta mimetic drug causes smooth muscle
relaxation by B2 receptor stimulation
Doses-given by iv infusion
Start with 100ug/min & increase the dose by
50ug every 10-20 min. till uterine contractions
stops
Maximum dose of 350ug
Continue infusion for 12 hours after the
contractions stops
25. Doses-0.2-0.5 mg/min iv infusion for 12 hours
followed by 10mg IM every 6-8 hours for 24
hours
SIDE EFFECTS OF BETA MIMETICS
Headache
Palpitation,tachycardia
Hypotension,hypokalemia
Pulmonary edema and cardiac failure
26. It is an excellent tocolytic but it is not used as
first line because it causes constriction of
ductus arteriosis.
Dose-initial dose 25-50mg orally followed by
25mg every 4-6 hours for 3 days
Side effects-heart burn, GI bleeding
Thrombocytopenia,asthma
27. Dose-4-6 gm(20% solution)iv slow in 20-30
minutes f/b an infusion of 1-2 gm/hr &
continue for 12 hours after the contraction have
stopped
Side effects
headache
flushing
muscular weakness
28. It is usually given in form of patch
Dose-0.1-0.4 mg/hr
Side effects –tachycardia
-headache
-hypotension
29. 1. Assess the mother’s condition to evaluate
signs of labour.
❑ Obtain a through obstetrics history
❑ Determine the frequency , duration,&
intensity of uterine contraction.
❑ Determine the cervical dilatation and
effacement.
❑ Assess the status of membranes, and
bloody show
