This document discusses premature labor or preterm labor. It defines premature labor as labor occurring before 37 weeks of gestation. It notes the incidence varies from 5-10% and identifies several risk factors like a history of preterm birth, infections, low socioeconomic status, and complications in the current pregnancy from maternal, fetal or placental issues. Diagnosis involves regular contractions with cervical changes. Management aims to prevent, arrest or appropriately handle preterm labor and provide effective neonatal care. Predictors include multiple pregnancy, history of preterm birth and infections while prevention focuses on reducing risk factors, early detection and prophylactic treatment.

1. PREMATURE
LABOUR(PRETERM
LABOUR
PRESENTED BY
MRS.JOHN BRITTO MARY
(PROFESSOR IN NURSING)

2. DEFINITION
• PML is defined as one where the labor before
the 37th completed week (<259 days),
counting from the first day of the last
menstrual period.

3. INCIDENCE
• The prevalence widely varies and ranges
between 5-10%.

4. ETIOLOGY
Unknown causes
• But ,the following are, however related with
increased incidence of premature labour.
High risk factors:
1.History-
• Previous history of induced or spontaneous abortion
or preterm delivery.
• Pregnancy following assisted reproductive
techniques(ART) .
• Asymptomatic bacteriuria or recurrent urinary tract
infection, Smoking habits .
• Low socio – economic and nutritional status.
• Maternal stress.

5. • 2.complications in present pregnancy: may be
due to
• Maternal
• Fetal
• Placental

6. • Maternal –Pregnancy complications, uterine anomalies,
medical and surgical illness, chronic diseases, genital tract
infection
PREGNANCY COMPLICATIONS: Preeclampsia, APH, PROM,
Polyhydrominos.
• Uterine anomalies: Cervical incompetence, Malformation of
uterus.
• Medical and surgical illness: Acute fever, Acute pyleonephritis,
Diarrohea, Acute diabetes, Decompensated heart lesions,
severe anemia, low body mass index(LBMI).
• Genital tract infection: BACTERIAL vaginosis, Beta haemolytic
streptococcus, Bacterioides, Chlamydia, Mycoplasma.
• Fetal- Multiple pregnancy, Congenital malformations , Intra
uterine death.
• Placental- Infraction , Thrombosis , Placenta previa , or
Abruptia placenta.

7. • 3.Itrogenic: indicated preterm delivery due to
medical or obstetric complication.
• 4.Idiopathic(majority): premature effacement
of the cervix with irritable uterus and early
engagement of the head are often associated .

8. DIAGNOSIS
• Regular uterine contractions with or without pain (at least
one in every 10 minute)
• Dilatation>2cm and effacement 80% of the cervix
• Length of the cervix <2.5cm
• Pelvic pressure, backache and vaginal discharge or bleeding

9. INVESTIGATIONS
• Full blood count
• Urine for routine analysis,culture and
sensitivity
• Cervico vaginal swab for culture and
fibronectin
• Ultrasonography for fetal well being, cervical
length and placental location
• Serum electrolytes and glucose levels.

10. MANAGEMENT:
• To prevent preterm onset of labour
• To arrest preterm labour, if not
contraindicated
• Appropriate management of labour
• Effective neonatal care

11. FIRST STAGE:
• The patient is put to bed to prevent early
rupture of membranes.
• To ensure adequate foetal oxygenation by
giving oxygen to the mother by mask.
• Epidural analgesia is of choice.
• Labour should be carefully monitored
preferably with continuous EFM.
• Caesarean delivery is done for obstetric
reasons only.
• NICU is a sin-quanom for good outcome.

12. SECOND STAGE:
• The birth should be gentle and slow to avoid
rapid compression and decompression of the
heal.
• Episiotomy may be done to minimise heal
compression if there is perineal resistance.
• Tendency to delay is curtailed by low forceps. as
such, routine forceps is not indicated.
• The cord is to be clamped immediately at birth to
prevent hypervolaemia and hyperbilirubinaemia.
• To shift the baby to neonatal intensive care unit
under the care of a neonatologist.

13. PREDICTORS OF PREMATURE LABOUR:
• Multiple pregnancy
• History of preterm birth
• Presence of genital tract infection
• Symptoms of PTL

14. PREVENTION OF PML:
• Primary care is aimed to reduce the incidence
of preterm labour by reducing to high risk
factors eg.infection.
• Secondary care includes screening tests for
early detection and prophylactic treatment
eg.tocolytics.
• Tertiary care is aimed to reduce the perinatal
morbidity and mortality after the diagnosis
eg.use of corticosteroids.