Preterm labor is defined as regular uterine contractions before 37 weeks of gestation that can lead to cervical changes and dilation. It may occur spontaneously or be indicated due to fetal or maternal complications. Common causes include intrauterine infection, cervical incompetence, premature rupture of membranes, and multiple pregnancies. Risk factors include African American race, young or advanced maternal age, prior preterm birth, smoking, and short time between pregnancies. Management involves bed rest, hydration, monitoring, tocolytic medications to stop contractions if possible, corticosteroids for fetal lung maturity, and antibiotics if membranes have ruptured. Complications include increased C-section rates and respiratory, feeding, and developmental issues for preterm infants.

1. Preterm labor
Prepared by : abdulrahman farhad
Supervised by : dr.erteqa

2. Definition:
● It is a regular contractions of the uterus that occurs before 37 weeks ( 24 wk -
36 wk+6 days) of gestation and results in cervical dilatation and effacement.
● Extremely preterm: <28 weeks.
● Early preterm: 28-32 weeks.
● Late preterm: 32-37 weeks.
● It may be spontaneous preterm labor or indicated ( fetal and maternal
indications) or it may follow PROM.

4. Causes:
● Intrauterine infection ( chorioamnionitis).
● Abruptio placenta.
● Cervical incompetence.
● PROM.
● Multiple pregnancy.
● Intrauterine death.
● Fetal and uterine abnormalities.
● Genetic factors.
● Hypertensive disorders ( pre- eclampsia).
● Unknown.

5. Risk factors:
● Modifiable : cigarette smoking,substance abuse,absent prenatal care,short
interpregnancy intervals,anemia,bacteruria/UTI,genital infection,strenuous
work,high stress, pyelonephritis.
● Non-modifiable: African-American race,age <18 or > 40 years,prior preterm
birth,poor nutrition,low pregnancy weight,uterine anomaly or
fibroid,polyhydramnios, premature cervical dilatation (>2 cm) or effacement
(>80%).
● Fetal and placental factors: IUGR , vaginal bleeding, APH,placenta
previa,fetal congenital anomalies.
● Other factors: trauma,bleeding disorders .

7. Sign and symptoms:
● Change in the vaginal discharge ( watery,mucus or bloody) or more vaginal
discharge than usual.
● Abdominal cramps with or without diarrhea.
● Backache.
● Pressure in the pelvis and lower abdomen.
● Regular uterine contractions with or without pain.
● Feeling that the baby is pushing down.
● Water breaks.

8. Examination:
● General examination to look for signs of dehydration,systemic infection.
● Vital signs.
● Abdominal examination for uterine contractions,fundal height,lie and presentation
of the baby.
● Gynecological examination: speculum examination for signs of rupture of
membranes,cervical effacement and dilatation,bulging of the membranes,fetal
fibronectin test,culture for ( chlamydia,gonorrhea,group b streptococcus) outer ⅓
of the vagina and perineum.
● Cervical examination : after rupture of the membranes was ruled out,when there is
suspicion of placenta previa.
● Ultrasound examination (abdominal): placental location,amniotic fluid volume,fetal
weight and presentation,fetal well- being.

9. ● Tansvaginal ulstrasound: for placental location and cervical length ,if the
cervical length is < 20 mm and there is contractions this is preterm labor,if it
was 20-30 mm and there is contractions this is probably preterm labor ,if it
was >30 mm preterm labor is very unlikely regardless of the contractions,
transvaginal uss also shows the presence of sludge.

10. Management:
● Bed rest.
● Hydration.
● Monitoring of the fetal heart/ CTG.
● Tocolytic medications : commonly used medications are calcium channel
blockers( nifedipine),mg sulfate,oxytocin antagonist (atosiban). Less
commonly used drugs are beta
agonists(terbutaline,ritordine,isoxsuprine),prostaglandin
inhibitors(indomethacin,sulindac,ketorolac),nitric oxide donors (
nitroglycerine).
● Corticosteroids: betamethasone or dexamethasone.
● Antibiotics if there is PROM.

11. Contraindications to tocolytic medications:
● APH.
● Maternal hemodynamic instability.
● Severe pre-eclampsia & eclampsia.
● IUGR.
● Chorioamnionitis.
● Fetal death.
● Fetal anomaly incompatible with life.
● Severe bleeding from any cause.

12. Prevention:
● Lifestyle modification: smoking cessation,adequate nutrition.
● Treatment of bacterial vaginosis.
● Progesterone.
● Cervical cerclage.

13. Complications
● Maternal: increased risk of caesarean delivery,complications of tocolytic
medications.
● Fetal : RDS,Intraventricular hemorrhage,NEC,bronchopulmonary
dysplasia,feeding problems( reduced or absence sucking reflex),neonatal
infection& infection,birth
trauma,hypothermia,hypoglycemia,hypocalcemia,hypomagnesemia,hyperbilir
ubinemia ,perinatal asphyxia,long term neurological sequel.

14. Thank you