Preterm labor occurs before the 37th week of gestation, with risk factors including previous preterm labor, pre-eclampsia, and multiple pregnancies. Diagnosis relies on regular contractions, cervical dilation, and effacement, while predictors like fetal fibronectin and cervical length aid in assessing risk. Management includes bed rest, hydration, glucocorticoids for fetal lung maturation, and careful monitoring during labor.

2. TABLE OF CONTENTS
• DEFINITION
• RISK FACTORS
• ETIOPATHOGENESIS
• DIAGNOSIS
• TYPES
• PREDICTION
• ARREST
• MANAGEMENT

3. DEFINITION
 Preterm labor is defined as one where the labor starts before the 37th
completed week, counting from the first day of the last menstrual
period.

4. RISK FACTORS
A previous H/O preterm labor: Most consistent risk factor
Pre-eclampsia
Multiple pregnancy
APH
PROM
Polyhydramnios
Genital/ urinary tract infection
Low socio-economic status
Maternal smoking.

5. ETIOPATHOGENESIS

6. DIAGNOSIS
It is better to overdiagnose preterm labor than to ignore the
possibility of its presence.
Diagnostic points are:
1. Regular uterine contractions (at least 1 in every 10 minute)
2. Cervical dilatation (> 2 cm)
3. Cervical effacement (80%)
4. Length of the cervix (measured by TVS) < 2.5 cm and funneling of
the internal os.

7. TYPES
• EARLY preterm labour: Other diagnostic criteria + cervical dilatation 1-
3 cm
• ADVANCED preterm labour: Other diagnostic criteria + cervical
dilatation >3 cm
• THREATENED preterm labour: Cervical length of <2.5 cm (measured
by TVS) + No uterine contractions.

8. PREDICTORS OF PRETERM LABOUR
• Fetal fibronectin:
Fibronectin is a glycoprotein that binds the fetal membranes to the
decidua.
Normally it is found in the cervicovaginal discharge before 22 weeks
and again after 37 weeks of pregnancy.
Presence of fibronectin in the cervicovaginal discharge between
24 and 34 weeks is a predictor of preterm labor.
When the test is negative it reassures that delivery will not occur
within next 7 days.
• Cervical length as measured by TVS: <2.5 cm by 24 weeks.

9. MEASURES TO ARREST PRETERM LABOUR
• Bed rest in left lateral position
• Adequate hydration
• Glucocorticoids
• Prophylactic cervical circlage (in some cases)
• Tocolytics*.
* Note: Tocolytics should preferably be avoided as there is no clear
benefit (RCOG–2002).

10. TOCOLYTICS

12. GLUCOCORTICOIDS
• Maternal administration of glucocorticoids is advocated where the
pregnancy is <34 weeks.
• This helps in fetal lung maturation so that the incidence of RDS, IVH
and NEC are minimized.
• This is beneficial when the delivery is delayed beyond 48 hours of the
first dose. Benefit persists as long as 18 days.
• Either betamethasone 12 mg IM 24 hours apart for 2 doses or
dexamethasone 6 mg IM every 12 hours for 4 doses is given.
• Betamethasone is the steroid of choice (RCOG – 2004).

13. MANAGEMENT OF PRETERM LABOUR
FIRST STAGE SECOND STAGE
 Bed rest
 Ensure adequate fetal oxygenation
(by giving oxygen by mask to mother)
 Epidural analgesia
 Labor should be carefully monitored
preferably by through continuous CTG
 LSCS only in case of obstetric reasons
only.
 Birth should be gentle and slow
 Episiotomy to reduce head
compression
 Clamping the cord immediately after
birth (to reduce hyperbilirubinemia)
 To shift the baby to NICU.

14. Thank you….
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