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PRETERM LABOUR
• Delivery between 20 & 37
weeks gestation
• Different from LBW
–LBW <2500Gm
–Very LBW <1500Gm
–Extremely LBW <1000Gm
• Major cause of foetal,
perinatal & Infant death
• High cost of survival
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PRETERM LABOUR
THE PROBLEM…
Cause-Uncertain
Diagnosis-Elusive
Methods-Debatable
Results-Unpredictable
Cost- Enormous
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MANAGEMENT OF PRETERM LABOUR
DETECT & ELIMINATE / TREAT
THE CAUSE: -
INFECTION
CERVICAL INCOMPETENCE
PLACENTA PREVIA / ABRUPTION
UTERINE ANOMALIES
PIH
FOETAL ANOMALIES
IMMUNOLOGICAL?
PATIENTS AT RISK
THREATENED PRETERM
DELIVERY (Active preterm labour)
PRETERM PROM
METHODOLOGY
Multi-component
preventive programs
1.Risk assessment:-
1.Education:-
Staff
Patients
Public
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
Support systems: -
Home visiting nurses/
midwives
Home help
Family help
Social worker assignment
Stress management classes
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
Self-monitoring of uterine
activity at home: -
-External tocodynamometer
1.Advice: -
Reduce work
Reduce housework & child
care
Reduce smoking
Reduce stress
Reduce travel,
commuting, moving house
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
1.Advice: -
Reduce / Stop sexual
activity
Bed rest at home
Avoid hot & humid climate
Improve nutrition(Sea
Fish+)
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
1.Antenatal care: -
Increased frequency of
contact
Continuity of care
Facilitated access to
tertiary hospital
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
1.Antenatal care: -
Over Hydration (1.4
Gallons/day)
High dose calcium
Antioxidants
Regular cervical
examinations (No
digital Exam.please)
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
1.Antenatal care: -
Testing for imminent
preterm labour with
biological markers-
Foetal Fibronectin(FFN)
E V Ultrasound of Cx.
Salivary estriol
(E3)(SalEst Test).
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MANAGEMENT OF PATIENTS AT RISK
Multi-component preventive programs
1.Specific obstetric
interventions:-
•HOSPITALISATION
•COUNSELLING
•HYDRATION- Oral / IV
•SEDATIVES
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MANAGEMENT OF THREATENED
PRETERM DELIVERY
Foetal factors -
Severe IUGR
Foetal Anomaly incompatible with life
Foetal distress
It is a nitric oxide
donor
Good for very short
periods
Hypotension
A Designer Drug
A selective ß2 –Adrenergic
receptor modulator
Patient History
Fluid Observation
Ulrasound
Nitrazine Test
Ferning Test
Dye Injection
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MANAGEMENT OF PRETERM PROM
GOAL
To Prolong Pregnancy till lung maturity
preferably up to 33weeks
• Hospitalisation
• Monitor for-
Infection → Antibiotics
Labour → Tocolysis(<34 weeks)
Foetal well being → USG
• Promote Lung maturity → Steroids
• Amnio infusion
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Intra Partum Managements of
Preterm Labour
Minimise Maternal Hypotension and
Foetal hypoxia and acidosis➝ < RDS
Routine use of prophylactic forceps &
episiotomy not recommended
If Foetal distress- CS?
Below 28 weeks - NO CS
Below 32 weeks - ?
Above 32 weeks - CS
Vertical skin & uterine incision
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Survival Rate According to Gestational Age &
Birth Weight
(Oklahoma Medical Center, 1981-1994)
= CORRECT MANAGEMENT
FOR THE INDIVIDUAL.