PRE-TERM LABOUR

 When labour  starts before 37th weeks completed counting from first day of LMP.

It occurs before the 37 completed weeks

Contraction occur more frequent than every 10 minutes last for 30 second or longer

It may be associated C infection

Type- (i) Spontaneous Pre- term labour

(ii) Elective Pre- term labour

Etiology:- History of preterm delivery recurrent urinary tract infection

Smoking habits

Nutritional status Low socio- ecostatus

Pregnancy complications:-

(1) Maternal:-

Pre eclampsia, APH, PROM, Polyhydramnios

Uterine anomalies Uterine malformation, Acute fever

Pylonephritis, diarrhea

Acute Appenditis, severe anemia

Toxoplasmosis, hypertension, DM

Nephritis

(2) Fetal:- Multiple Phage

Congenital Malformation

Intra uterine death

(3) Placental:-

Infection, thrombosis

Placenta previa

Abruption placenta

Pre mature effacement of cervix

Early Engagement of Head

Investigation:- Full blood count, Urine for routine analysis

Crevice- Vaginal swab for culture

USG

Serum Electrolyte

Management:-

Principles:- To prevent preterm onset of  labour

To arrest preterm labour

Appropriate msg of labour

Effective neonatal case

Assessment:- Regular uterine contraction (Painful or painless)

Dilation (> 2 cm) and effacement 80% of cervix

Low back pain

Change in the character and amount of usual discharge may be thicker, thinner bloody, brown & color less

First stage:- Bed rest O2 inhalation

Avoid sedatives, close monitoring

Incase of delay CS should be done

Second stage:-Slow & gentle birth

Episiotomy

Clamp the card

Shift baby of NICU

Arrest of preterm labour:- Bed rest, Hydration, Antibiotic

Tocolytic Agent, Glucocarticoid

Beta methadone 12 mg IM BD

Dexamethasone 6 mg IM 4 time

Intervention:-  Focus on stopping the labour, identify & treat infection restrict activity & ensure hydration

Maintain bed rest

Monitor fetal status

Administer medication such as:-

Ritodrine (Uterine Relaxant)

Mg So4 (Anti conversant)

Terbutaline

Nefedipine

Indomethacin (Inhibit Prostaglandin Synthesis)