Preterm Labor

Pretem Labor
Ramzy Nakad, MD
Preterm Birth
• Definition: Birth that occurs prior to
completion of 37 weeks of gestation.
• Preterm birth is the leading cause of neonatal
mortality and the most common reason for
antenatal hospitalization .
• In the United States, approximately 12% of all
live births occur before term, and preterm
labor preceded approximately 50% of these
preterm births.
Preterm Birth
• Account for approximately 70% of neonatal
deaths and 36% of infant deaths as well as 25–
50% of cases of long-term neurologic
impairment in children.
• Estimated annual cost of preterm birth in the
United States to be $26.2 billion or more than
$51,000 per premature infant.
Preterm Birth
• Classified into two main categories.
• Spontaneous: Approximately 40-50% are due
to spontaneous preterm labor with intact
membranes and 25-40% due to preterm
premature rupture of the membranes.
• Indicated: Deliberate intervention for variety
of maternal or obstetric indications 20-30%.
Preterm Labor
• Definition: Cervical change before 37 weeks of
gestation due to regular contractions.
• Causes ?!?!?!?!
Pretem Labor:
• Risk Factors
Multifetal gestation
Prior preterm birth
Preterm uterine contractions
Premature rupture of membranes
Pretem Labor:
• Risk Factors
. Low maternal pre-pregnancy weight
. Smoking
. Substance abuse
. Short inter-pregnancy interval
Pretem Labor:
• Risk Factors:
Vaginal bleeding
Urinary tract infections
Genital tract infections
Periodontal disease
Prediction of Preterm Labor
• Recognize the signs and symptoms:
. Menstrual-like cramps
. Low, dull backache
. Abdominal/ Pelvic pressure
. Increase or change in vaginal discharge.
Prediction of Preterm Labor
• Cervical change:
• Short cervix detected by ultrasound has the most value
with people that are high risk patients (had a previous
preterm delivery or have an anatomic defect of the
• Early dilation and effacement of the crevix
Prediction of Preterm Labor
• Other modalities that showed no benefit in
improving outcomes of pregnancy in
asymptomatic women:
– Bacterial vaginosis
– Home uterine contraction monitoring
Prevention of Preterm Labor
• Historically nonpharmacologic interventions
such as bed rest, abstention from intercourse
and hydration were recommended; Evidence
for the effectiveness of these interventions is
lacking, and adverse effects have been
Prevention of Preterm Labor
• There are currently no uniformly effective
interventions toprevent preterm labor ,
regardless of risk factors.
Prevention of Preterm Labor
• Treatments that have been proved to affect
- 17OH caproate progesterone for patients
with history of preterm delivery.
- Progesterone for short cervix
- Antenatal corticosteroids
Betamethasone or Dexamethasone
- Targeted use of magnesium sulfate for fetal
Evaluation of a Patient With Suspected
Preterm Labor
History & Physical
Place patient on the external monitor
Cervical evaluation
- if PPROM use sterile speculum exam
• Collect cultures including GBS, GC and
perform a wet mount to rule out BV.
Management of Patients with Preterm
• Purpose in treating preterm labor is to delay
delivery if possible until fetal maturity is
• Corticosteroids up until 34 weeks.
• Tocolysis: Stopping contractions.
• Magnesuim Sulfate for neuroprotection up
until 32 weeks.
• Possible amniocentesis if infection is
Contraindications to Tocolysis
Intrauterine fetal demise
Lethal fetal anomaly
Nonreassuring fetal status
Severe preeclampsia or eclampsia
Maternal bleeding with hemodynamic instability
Preterm premature rupture of membranes*
Maternal contraindications to tocolysis (agent
Premature Rupture of Membranes
• PROM is the rupture of the chorioamniotic
membrane before the onset of labor; happens
with about 8% of term pregnancies.
Preterm PROM
• PPROM, defined as PROM that occurs before
37 weeks of gestation, associated with 30% of
preterm deliveries.
• Major complication is intrauterine infection.
• Consequences of PPROM depend on
gestational age.
• <22 weeks associated with incomplete
alveolar development.
PROM; Etiology
Smoking; two fold increase
Short cervix
Previous preterm labor
Multiple gestations
Threatened abortion
Fever > or = 100.5
Fundal tenderness
Tachycardia ( maternal and fetal)
Treatment is antibiotics and prompt delivery
ROM diagnosis
• Nitrazine test, amniotic fluid PH is above 7.1
turns blue
• Fern test
• Pooling
• Ultrasound?role
• Carmine dye
Evaluation and management
• History and Physical exam
• Sterile speculum exam, collect vaginal
cultures. GC-C, GBS.
• Ultrasound

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