Preterm labour

Question 1

Preterm labour - def

Answer 1

Def = delivery between 24 and 37 weeks

- Common presentation of preterm labour = SROM

Question 2

Preterm labour - RF

Answer 2

1. Previous preterm birth or late miscarriage
2. Multiple pregnancy
3. Cervical surgery or uterine anomalies
4. Infection or abruption
5. Pre-eclampsia and IUGR

Question 3

Preterm labour (acute) - ax

Answer 3

Hx

1. Pain/contractions - onset, frequency, duration, severity
2. Vaginal loss - SROM or PV bleeding
3. Obstetric hx (check notes)

Ex

1. Maternal pulse, temperature, respiratory rate
2. Uterine tenderness (suggests infection/abruption)
3. Fetal presentation
4. Speculum - look for blood, discharge, liquor. Take swabs
5. Gentle VE (not if PPROM!)

Ix

1. FBE, CRP (if raised, suggest infection)
2. Swabs
3. MSU
4. U/S for fetal presentation (malpresentation common) and estimated fetal weight (EFW)
5. Consider fetal fibronectin (a protein not usually present in cervicovaginal secretions at 22-36 weeks; if +ve, more likely to deliver)

Mx

1. Establish whether threatened or ‘real’ preterm labour - cervical length and fibronectin assay (?). Admit if high risk, inform neonatal unit and check fetal presentation with U/S
2. Steroids (betametasone IM - 2 doses, 24h apart)
3. Consider tocolysis (nifedipine, terbutaline) - if intact membranes?
4. Liaise with obstetrician + neonatologist (esp if at margins of viability - 23 to 26 wks) - plan for mode of delivery + intervention if needed
5. Give IV abx but only if labour confirmed