PRETERM LABOUR MANAGEMENT

Principles of management

Initial assessment must be

done to ascertain cervical
length and dilatation and
the station and nature of
the presenting part.*
Identify treatable causes
(such as a urinary tract or
vaginal infection)
Should be placed in the
lateral decubitus position,
monitored for the
presence & frequency of
uterine activity & cervical
changes..
High vaginal swab.(B
strep, Ureaplasma,
Mycoplasma,Gardnerella
vaginalis)*
Blood sugar, CBC, serum
electrolytes level,
urinalysis, and urine
culture and sensitivity.

Tocolytic agents

Ultrasound (dates, cause,

growth).
Rest and fluids will
improve 50 % of cases.
HOW?
By the inhibition of the ADH
released from the post
pitutary gland from the same
site where oxytocin is
released..
It is acceptable to
administer antibiotics *to
patients who are in
preterm labor (a 7-day
course of ampicillin and/or
erythromycin).. **allergy
use clindamycin or
vancomycin ..
To prevent the
progression of a silent
infection to clinical
amnionitis
Tocolytic therapy
if the patient doesnt respond
to bed rest & hydration

Used to reduce and

stop uterine
Contraction .
We use them for 48-72
hours *..
1)corticosteroids work
2)in cases we dont have
good NICU facilities until we
transfer the pt. to another
hospital.

Tocolytics are routinely

used at less than 34
weeks gestation if there
are no contraindications
to treatment.
Treatment is
individualized from 34-37
weeks.

Contraindications to
Tocolysis
1. Severe PET
2. Severe APH
3. IUGR
4. Chorioamnionitis
5. Fetal anomalies
6. Cardiac disorders,
Arrhythmias.
7. Thyrotoxicosis.
Tocolytic agents
1.
Magnesium sulfate
2.
Calcium channel
blocker (nifedipine)
3.
Sympathomimetic
agents (ritodrine,
terbutaline)
4.
Prostaglandin
inhibitors
(indomethacin)
5.
Atosiban

.
Sympathomimetic
agents
Ritodrine
hydrochloride
Salbutamol
MgSO4

Action
Decrease intracellular
Ca

TOCOLYTIC AGENTS
Side effects
1. Fetal and maternal
tachycardia.
2. Hypotension.
3. Rarely chest pain.
4. Hyperglycemia.
5. Hyperkalemia.
6. Right heart failure

Competes with Ca+2 for

entry into the cell
decrease free
intracellular Ca

respiratory depression
and cardiac conduction
defect.

Notes
Dose control by maternal response
and pulse

Atosiban

Oxytocin antagonist

Higher doses are required (1 gm 4

hourly orally) compared to
eclampsia
Useful in selected cases such as
diabetes, heart diseases
Strict serum levels should be
observed
It is used as an intravenous
medication to halt premature
labour..

PG synthetase
inhibitors
Indomethacin
Aspirin
Flufenamic acid

It prevents conversion
of arachidonic acid into
PG

nifedipine inhibit slow

Animal studies showed fetal
inward of calcium ions
acidosis
during the second
phase of action
potential of uterine
smooth muscle cell.
Is tocolytic therapy effective?
Failed to decrease preterm incidence in large population studies.
It did prolong gestation, decreased RDS , improved neonatal survival & increased birth weight.
Use after 34 weeks is limited.
All agents delayed labour by 72 hours in 80% of treated patients
Ca channel blockers
Nifedipine

If prolonged use:
a. Oligohydramnios.
b. Premature closure of
ductus arteriosus(May
lead to neonatal PHTN &
CF)
c. Platelet dysfynction.
Has minimal side effect :
a. Headache
b. Flushing
c. hypotension
d. tachycardia

Role of Glucocorticoids
Reduces the mortality, RDS &
IVH ..
It`s recommended use up to
34 weeks.
Dose consists of :
**2 doses of 12 mg of
betamethasone(Development
of CNS), IM 24 hours apart or
** 4 doses of 6 mg of

Surfactant
Phospholipids
i.
Phosphotidyl
lecithin
ii.
Phosphotidyl-inositol
iii.
Phosphotidylglycerol
Proteins
Carbohydrate
Salts and neutral lipids

Lung maturity
Fetal lungs are
mature if:
1)Phosphatidylglycerol
is present in amniotic
fluid
or
2) Lecithin
sphingomyelin (L/S)
ratio is > 2

L/S ratio
>2 indicates lung maturity.
Lecithin increases from 35
weeks onward while
sphyngomyline remains
constant after 35 weeks
Measured by liquid
chromatography.
2% of infant with L/S>2
develop RDS

dexamethasone, IM, 12 hours

apart.
SO ,It has both
prophylactic and
therapeutic use.

It is produced by
pneumocytes type II
(proliferates at 24
weeks and function by
34 week)

Blood and meconium may

reduce the L/S ratio but has no
effect on PG detection.