PRETERM LABOUR

Lekshmi L V2007 MBBS

DEFINITION

Preterm labour – spontaneous expulsion of products of conception after viability and before 37 completed weeks.

Threatened preterm – uterine contractions +

but no corresponding cx dilatation

Incidence is increasing; No specific etiology

RISK FACTORS

Infections of genital tract - chorioamnionitis

Past reproductive history –

prev. preterm birth is the single most important risk factor

prev. induced abortion or 1st/2nd trimester loss

Maternal factors

extremes of age

under nutrition

low socioeconomic status

smoking

stress

lack of ANC

Pregnancy complications

Multiple pregnancy Polyhydramnios Asymptomatic bacteriuria APH Pre eclampsia Fetal malformations Maternal illness or systemic inf

Uterine factors

cervical incompetence uterine anomalies submucous fibroid

TYPES

Spontaneous

Iatrogenic – IUGR, pre eclampsia, abruption

Preterm PROM

PREDICTION OF PRETERM LABOUR

Prior preterm labour

Clinical cervical assessment

TVS cervical assessment – 2.5cm cut off

Fetal fibronectin - ≥ 50 ng/ml

Other markers – maternal salivary oestriol, plasma CRH

Home uterine activity monitoring

In a women with previous preterm labour, fetal fibronectin ≥ 50 ng/ml & cervix length < 2.5cm on TVS – best predictor

DIAGNOSIS

CRITERIA :

Contractions – 4 in 20 min

Cx dilatation > 1cm

Cx effacement – 75% or more

PREVENTION

Improve general health & nutrition

Better antenatal care

Cx encerclage for incompetence

Conservative management of PROM

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