Obstetrics and Gynecology/Preterm Labour

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Pre-Term Labour[edit]

Definition[edit]

  • Labour occurring between 20 and 37 weeks gestation.

Etiology[edit]

  • 30% idiopathic
  • 30% related to pre-labour rupture of membranes
  • The rest related to a myriad of other factors

Management[edit]

Antibiotics[edit]

  • Not-recommended for women in pre-term labour with intact membranes

Corticosteriods[edit]

  • Corticosteriods (betamethasone) should be administered to promote fetal pulmonary development. However, multiple doses should be approached with caution.

Tocolysis[edit]

  • Using atosiban, indomethacin, nifedipine
  • Contraindications to tocolysis include
    • Non-reassuring fetal status
    • Dilated cervix >4cm
    • Suspected intrauterine infection
    • Gestational age >34 weeks or <23 weeks
    • Intrauterine fetal death
    • Fetal anomaly incompatible with life
    • Maternal deterioration necessitating delivery

Pre-Labour Rupture of the Membranes[edit]

Definition[edit]

  • Pre-labor rupture of the membranes (PROM) may occur at pre-term or term dates. PROM poses a significant risk for pre-term labour.

Epidemiology[edit]

  • PROM occurs in less than 30% of pregnancies.

Management[edit]

  • Antibiotics will prolong the latent phase of labour, prevent/treat ascending infection, and reduce the incidence of complications with prematurity.