Preterm Labor & Premature Rupture of Membrane PDF

# Preterm Labor Preterm labor occurs after viability and before 37 weeks gestation when regular uterine contractions dilate the cervix. It is divided into two types: early, before 33 weeks; and late preterm labor, between 34 and 36 weeks. ## Risk factors for preterm labor - History of preterm la...

# Preterm Labor Preterm labor occurs after viability and before 37 weeks gestation when regular uterine contractions dilate the cervix. It is divided into two types: early, before 33 weeks; and late preterm labor, between 34 and 36 weeks. ## Risk factors for preterm labor - History of preterm labor - History of middle trimester miscarriage - History of premature rupture of the amniotic membrane - Short cervix < 2.5 cm at 20-25 weeks, by endovaginal US - Diabetes with pregnancy - Hypertension - Infections. These are bacterial vaginosis, urinary tract infection and bacteriuria. Group B streptococcal maternal colonization - History of cervical surgery - Cigarette smoking and use of illicit drugs, e.g. cocaine and heroin - Abruptio placentae - Polyhydramnios ## Clinical presentation - Lower abdominal pain and back ache - Passage of show - Passage of fluid via the vagina ## Signs - Uterine contractions can be palpated per abdomen - Tocography can be used to ensure the presence of contractions - But the cardinal sign of labor is cervical dilatation diagnosed by p.v. ## Investigations required - High vaginal swab and endocervical swab for culture and sensitivity - Total white cell count - Urine analysis - Endovaginal US scan for measuring the cervical length ## Management - If gestational age 34 weeks and more, give: - Steroid to enhance lung maturity. - Dexamethasone 12 mg 12 hourly IM for four doses. - Or Betamethasone 12 mg IM 24hourly for 2 doses. - When the gestational age is less than 34 weeks, give tocolytic drugs - Indomethacin: 100 mg per rectum for 4 doses. For 48 hours, then 50 mg orally BID for 2 days. Not prescribed after 32 weeks. - Contraindications for indomethacin: - Maternal and fetal renal disease - Severe oligohydramnios - Magnesium sulfate: - Effective dose. - Contraindicated in myasthenia gravis and hypotension - Side effects: - Muscle weakness, lethargy, headache, flushing, dry mouth, pulmonary edema, and cardiac arrest - Drug level is measured in case of high creatinine, or oliguria - Nifedipine: - Improves neonatal outcome - Dose 30 mg loading, then 10 to 20 mg every 4 hours. - Contraindicated in hypotension - Causes flushing edema and headache - Terbutaline: - Dose 0.25 mg 20 to 30 minutes up to 3 doses. - Contraindicated in heart disease, uncontrolled diabetes, and thyrotoxicosis. # Premature Rupture of the Membrane Rupture of the amniotic fluid after viability and before the onset of labor, prom when it occurs before 37 weeks, it is called preterm prom (p prom). ## Risk factors: - Low body mass index - Previous miscarriage - Previous preterm labor - Previous prom - Diabetes mellitus - Hypertension - Abnormal vaginal discharge - Genital tract infection - Malposition and mal presentation - Increased intraabdominal pressure ## Causes of prom: - Unknown - Genital tract infection - Polyhydramnios - Preterm labor - Low body mass index - Low socioeconomic class - Illicit drug use ## Symptoms and Signs: - Passage of fluid via the vagina ## Confirmation of diagnosis: - Using speculum, the external os of the cervix can be visualized. If the liquor is seen coming through the external os, this confirms the diagnosis of prom. This procedure is done under aseptic technique, using a sterile, speculum and surgical gloves. It needs a good light. ## Complications of prom: - Intra amniotic infection leading to septicemia, maternal and fetal death - Abruptio placentae, Cord prolapse - Cord compression during labor - Fetal pulmonary abnormality - Increased rate of cesarean section - Neonatal complications of prom: prematurity with all complications of prematurity e.g. RDS ## Investigations required: - A fluid sample from the posterior vaginal fornix pool to be subjected for analysis, microbiology, culture and sensitivity. ## Management of prom: - 24 weeks gestation up to 34 weeks: - Corticosteroids for maturity - Antibiotics: - Erythromycin orally - Ampicllin - Amoxicillin - 32 up to 33 weeks lung maturity can be tested by examining the amniotic sample from the vaginal pool. ## Monitoring: - Observe maternal and fetal temperature - BP - Uterine tenderness - Vaginal discharge - PROM: > 34 weeks: Review dating and induce labor. - Avoid vacuum - Level 3 nursing # Thanks