What is preterm labour? INCIDENCE OF PRETERM LABOUR RISK FACTORS OF PRETERM LABOUR DIAGNOSIS OF PRETERM LABOUR Predictors of Preterm Labour INVESTIGATIONS Management Management in labour Referrences are given below

1. WELCOME TO
MORNING SESSION
Department Of Obstetrics & Gynaecology
North East Medical College & Hospital

2. PRETERM LABOUR
Presented by:
Dr. Afsana Akter Rima
Intern Doctor
Supervised by:
Dr. Sheuly (IMO)

3. Definition:
Preterm labour is defined as one
where the labour start before the
37th completed week(<259 days),
counting from the first day of the
last menstrual period (LMP).
What is preterm
labour?

4. INCIDENCE OF PRETERM LABOUR
⚫Incidence:
The prevalence of preterm labour widely
varies.
📊 It ranges between 10% – 15% globally.

5. IDIOPATHIC CAUSES
OBSTETRIC & MEDICAL HISTORY:
➤ ~50% of cases have no identifiable cause.
➤Previous history of induced or spontaneous abortion
History of preterm delivery
➤Pregnancy following ART (Assisted Reproductive
Technology)
➤Asymptomatic bacteriuria
Recurrent urinary tract infections (UTI)
➤Smoking
➤Low socioeconomic status and nutritional status
01.
02.
RISK FACTORS OF PRETERM LABOUR

6. 03.
Complications in Present Pregnancytyle &
Socioeconomic Factors
Complications may arise from:
▫️(a) Maternal causes
▫️
(b) Fetal causes
▫️
(c) Placental causes

7. (1) Pregnancy-related Complications:
Pre-eclampsia
Antepartum Hemorrhage (APH)
Premature Rupture of Membranes (PROM)
Polyhydramnios
(2)Uterine anomalies (e.g., malformations)
Cervical incompetence
(A) MATERNAL

8. (3) Medical & Surgical Illnesses:
Acute fever
Acute pyelonephritis
Diarrhoea
Acute appendicitis
Toxoplasmosis
History of abdominal operations
Cont....

9. Cont.....
(4) Chronic Medical Conditions:
Hypertension (HTN)
Diabetes Mellitus (DM)
Chronic Nephritis
Severe Anaemia
Decompensated heart disease /
Congenital heart lesions

10. (5) Genital Tract Infections:
Bacterial Vaginosis
Group B Streptococcus
Bacteroides
Chlamydia
Mycoplasma
Cont...

11. Multiple pregnancy (e.g., twins, triplets)
Congenital malformations
Intrauterine death (IUD)
(B) FETAL

12. Placental infarction
Thrombosis
Placenta previa
Placental abruption
(C) PLACENTAL

13. Medically indicated preterm delivery due to
Severe maternal medical conditions or
Serious obstetric complications
Iatrogenic:
4.

16. DIAGNOSISOFPRETERMLABOUR
🔹 1. Uterine Contractions
▪ Regular uterine contractions (at least 1 in every 10 minutes)
▪ May occur with or without pain
🔹 2. Cervical Changes
▪ Cervical dilatation 2 cm
≥
▪ Cervical effacement 80%
≥

17. 🔹 3. Transvaginal Ultrasound (TVS) Findings
▪ Cervical length 2.5 cm
≤
▪ Funneling of the internal os
🔹 4. Associated Clinical Features
▪ Pelvic pressure
▪ Vaginal discharge or bleeding
▪ Low backache
Cont...

18. Predictors of Preterm Labour
Clinical :
History of preterm birth
Multiple pregnancy
Presence of genital tract infection
Symptoms of PTL
Biophysical :
Uterine contractions ( more then equal 4/hour)
Bishop score ( more than or equal 4)
Cervical length ( less than or equal 25mm)
Biochemical:
Fetal fibronectin in cervicovaginal discharge (>50 ng/ml)
Others IL-6,IL-8,TNF-alpha

19. INVESTIGATIONS
1. Complete blood count.
2. Urine for routine analysis and cultures.
3. Cervicovaginal swab for culture and
fibronectin
4. Ultrasonography for foetal well being ,cervical
length,placental location
5. Serum electrolyte, glucose level ( when
tocolytic agent are to be used)

20. Management
A. To prevent pre term onset of labour ( if
possible).
B. To arrest preterm labour (if not contraindicated).
C. Appropriate management of labour.
D. Effective neonatal care.

21. A. Prevention of Preterm Labour
• Primary care:Reducing the risk factors (e.g. infection).
• Secondary care: Secrenning tests for early detection and
prophylactic treatment (e.g. tocolytic).
• Tertiary care : to reduce the perinatal mortality and morbidity
after the diagnosis (e.g. use of corticosteriods).

22. B. Measures to Arrest Preterm Labour
a. Bed rest
b. Adequate hydration
c. Prophylactic antibiotic :to prevent neonatal GBS infection ( penicillin is
recommended)
d. Prophylactic cervical cerclage : for women with prior preterm birth

23. E.Tocolytic agents: to inhibit uterine contractions ( Nifedipine ,
Indomethacin)
• Attempt to tocolysis if :
 Confirmed gestataion age <37 weeks.
 Cervix <3cm dilated.
 No amnionitis,pre-eclamsia or active
bleeding.
 No foetal distress.
 NOTE: monitor maternal and fetal condition (pulse,BP, signs of respiratory
distress, uterine contractions,FHR, blood glucose, fluid balance)

24. F.Corticosteriods:
To improve fetal lung maturity and chances of neonatal survival
reduces the risks of complications of prematurity:
Respiratory distress syndrome
Intraventricukar henorrhage
Perinatal death
 Maternal administration of glucocorticoid ( when
pregnancy < 34 weeks):
 Betamethasone ( 12mg I/M 24 hours apart for 2 doses)
Or
 Dexamethasone ( 6mg I/M 12 hours apart for 4 doses)

25. G. Neuroprotectin:
• MgSO4 is used ( when pregnancy is <34 weeks).
• For prevention of cerebral palsy in infant and child.
• There are 3 dosing regimens:
 IV 4g over 20 mintues,then 1g/hour until delivery or for 24
hour,whichever come first.
 IV 4g over 30 minutes or IV bolus of 4g given as single dose.
 IV 6g over 30-50 minutes,followed by IV maintenance of 2g/hour.

26. First Stage Second Stage
Bed rest ( to prevent early ruptures of membrane) Birth should be gentle and slow
O2 inhalation to mothers Episiotomy may be done ( to minimize head
compression if there is perinatal resistence)
Epidural analgesia is of choice Tendency to delay is curtailed by low forceps
Careful monitoring of labour [referably with
continuous electronic fetal monitoring
The cord is to be clamped immediately ( to
prevent hypervolemia and
hyperbilirubinaemia)
Caeseran delivery is done for obstetric reasons
( HTN,Abruption,Malpresentataion)
To shift the baby to NICU
C.Management in labour

27. Referrences are given below
1.DC Dutta's Textbook of Obstetrics
2.OGSB GUidelines
3.Internet

28. Thank you
For listening and watching!