Premature Labour

Background

  • Defined as birth/labour occurring at < 36+6 weeks gestation and more than 22+0 weeks gestation
  • Around 50,000 babies are born premature every year (1.4% of births)
    • Around 30% are spontaneous (idiopathic); another 30% due to multiple pregnancy
    • Other risk factors include infection (main cause worldwide), preterm rupture of membranes, antepartum haemorrhage, cervical incompetence, congenital uterine abnormalities, antiphospholipid syndrome, diabetes mellitus, low maternal BMI (<19), low social class, Afro-Caribbean ethnicity, history of premature pregnancy

Diagnosis/Features

  • Painful uterine contractions >1:10 minutes PLUS one or more of
    • Objective evidence of cervical change
    • Rupture of membranes
    • A ‘show’
    • Cervix <1cm long and/or 2cm dilated

Investigations/Assessment

  • Assess foetal heart rate (NB CTG may only be used >26+0 weeks)
  • Speculum examination (cervical assessment; microbiology (HVS); possibility of ROM)
    • Do NOT perform digital examination if SROM is suspected (safe to do so otherwise)
  • Also take urine sample for urinalysis and culture (infection can trigger labour)
  • Other investigations may include USS to check for foetal abnormality and lie/presentation if this has not already been identified

Management

  • Steroids should be given to all women if gestation is >24+0 and < 34+6 weeks and delivery is not imminent
    • If caesarean section is being planned, consider steroid use in patients up to 38+6 weeks gestation
    • In patients <24+0 weeks, consult with a specialist
    • A complete course is 2 doses of dexamethasone or betamethasone 12mg IM 24 hours apart
  • If membranes have ruptured, consider antibiotic treatment (e.g. erythromycin 250mg QDS for 10 days or cefuroxime 1.5g TDS + metronidazole 500mg TDS +/- gentamicin if signs of sepsis)
    • AVOID co-amoxiclav
  • Tocolysis (e.g. nifedipine)
    • Only really advised in patients requiring urgent transfer to a specialist unit, those in very preterm labour or those who have not completed full dose of steroids
    • Other indications include:
      • In suspected or proven pre-term labour between 24+0 and 34+0 weeks
      • If cervix is <4cm dilated
      • with intact membranes
    • Relative contraindications include
      • ruptured membranes; foetal distress (delivery is more important); signs of intrauterine infection (delivery); antepartum haemorrhage; condition warranting delivery e.g. eclampsia
  • Magnesium sulphate may also be considered, particularly where there is ROM

ppp

 

See also the premature infant and complications of prematurity

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