Obstetrics and Gynecology/Preterm Labour

Pre-Term Labour

Definition

• Labour occurring between 20 and 37 weeks gestation.

Etiology

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

Management

Antibiotics

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

Corticosteroids

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

Tocolysis

• 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

Definition

• 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

• PROM occurs in less than 30% of pregnancies.

Management

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