Preterm Labor

epidemiology

Labor and delivery between 28 36+6 weeks 5%-10%

be the leading cause of perinatal morbidity and mortality Survival rates have increased and morbidity has decreased because of technologic advances

Risk Factors
Previous preterm delivery Low socioeconomic status Maternal age <18 years or >40 years Preterm premature rupture of the membranes Multiple gestation Maternal history of one or more spontaneous second-trimester abortions Maternal complications (medical or obstetric)

 Uterine causes Myomata (particularly submucosal or subplacental) Uterine septum Bicornuate uterus Cervical incompetence Abnormal placentation

 Infectious causes Chorioamnionitis Bacterial vaginosis Asymptomatic bacteriuria Acute pyelonephritis Cervical/vaginal colonization Fetal causes Intrauterine fetal death Intrauterine growth retardation Congenital anomalies

diagnosis

cervical effacement and/or dilatation increased uterine irritability before 37 weeks of gestation

forecast: uterine activity monitoring. Ultrasound Examination Cervical length Fetal Fibronectin

of

treatment

Bed Rest Tocolysis Corticosteroid Therapy Antibiotic Therapy

Although bed rest is often prescribed for women at high risk for preterm labor and delivery, there are no conclusive studies documenting its benefit. A recent meta-analysis found no benefit to bed rest in the prevention of preterm labor or delivery.

Tocolytic therapy may offer some short-term benefit in the management of preterm labor. A delay in delivery can be used to administer corticosteroids to enhance pulmonary maturity and reduce the severity of fetal respiratory distress syndrome,

also be used to facilitate transfer of the patient to a tertiary care center No study has convincingly demonstrated an improvement in survival, long-term perinatal morbidity or mortality, or neonatal outcome with the use of tocolytic therapy alone.

Tocolytic Therapy Magnesium sulfate (Intracellular calcium antagonism) Terbutaline (Bricanyl) Beta2adrenergic receptor agonist sympathomimetic; decreases free intracellular calcium ions Ritodrine (Yutopar) Same as terbutaline Nifedipine (Procardia) Calcium channel blocker

Potential Complications Associated With the Use of Tocolytic Agents : Magnesium sulfate Pulmonary edema Profound hypotension* Profound muscular paralysis* Maternal tetany* Cardiac arrest* Respiratory depression*

Beta-adrenergic agents Hypokalemia Hyperglycemia Hypotension Pulmonary edema Arrhythmias Cardiac insufficiency Myocardial ischemia Maternal death

Indomethacin (Indocin) Renal failure Hepatitis Gastrointestinal bleeding Nifedipine (Procardia) Transient hypotension

Corticosteroid Therapy Dexamethasone and betamethasone for fetal maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in infants between 28 and 35 weeks of gestation. benefits start at 24 hours and last up to seven days after treatment The potential benefits or risks of repeated administration of

women who received antibiotics sustained pregnancy twice as long as those who did not receive antibiotics had a lower incidence of clinical amnionitis. poor fetal outcome (death, respiratory distress, sepsis, intraventricular hemorrhage or necrotizing colitis) occurred less