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Managing Preterm Labor & Birth: Family Medicine Specialist CME

Learn about preterm labor, its causes, diagnosis, and management. Understand the significance of preterm birth to infant health. Discover the essential interventions and treatments to reduce neonatal morbidity and mortality.

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Managing Preterm Labor & Birth: Family Medicine Specialist CME

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  1. Preterm Labor & Preterm Birth Family Medicine Specialist CME Vientiane, Lao PDR December 10 – 12, 2008

  2. Objectives • Define preterm labor and recognize significance to infant mortality & morbidity • Describe common causes of preterm labor • Describe how to diagnose preterm labor • Explain the management of preterm labor & preterm birth

  3. Preterm Labor • Regular uterine contractions • Progressive cervical dilatation • +/- effacement • Less than 37 weeks gestation • Usually results in preterm birth

  4. Preterm Birth • Birth occurring before 37 completed weeks of gestation • Dated from Last menstrual period (LMP)

  5. Incidence • Occurs in 7 – 10% of all pregnancies • Has not changed in 30 years in countries such like Canada • Approximately 1 – 2% of pregnancies deliver before 34 weeks gestation

  6. Significance • Babies born >34 weeks gestation in centres with NICU have survival rates equal to babies born at term • Babies born <34 weeks gestation have long term adverse outcomes • Respiratory complications • Central nervous system complications • Neurodevelopmental delays • Blindness & deafness • Babies born <30 weeks gestation have high mortality and morbidity

  7. Etiology • Preterm pre-labor rupture of membranes • Spontaneous preterm labor with intact membranes • Other causes • Placental abruption • Chorioamnionitis • Gestational hypertension • Abnormal fetal monitoring findings • Intrauterine growth restriction

  8. Risk Factors • Prior history of spontaneous preterm birth • Preterm pre-labor rupture of membranes • Antepartum hemorrhage • Uterine distension • Twins (multigestational pregnancy) • Polyhydramnios • Incompetent uterus/uterine abnormality • Fetal anomly

  9. Risk Factors • Infection • Chorioamnionitis • Bacteriuria • STI’s • Peridontal disease • Bacterial vaginosis + prior preterm birth • Drugs, smoking (>10 cigs/day), lifestyle • Domestic violence • Demographic factors • Maternal age <18 or >35 years of life • Maternal weight <55 kg - malnourishment

  10. Diagnosis • Early • Educate patients about early signs & symptoms of preterm labor • Contractions • Vaginal fluid loss • Vaginal bleeding • Maternal perception of vaginal pressure, low dull backache, vaginal discharge

  11. Diagnosis • Establish dates of pregnancy • LMP (Last Menstrual Period) • EDD (Estimated Date of Delivery) • Current gestational age • Identify risk factors • Evaluate for uterine contractions • Assess for cervical changes

  12. Management Objectives • Early diagnosis of preterm labor • Identify & treat underlying causes of preterm labor • Attempt to arrest labor, if appropriate • Intervene to reduce neonatal morbidity & mortality

  13. Prolongation of Pregnancy • Use of tocolysis to prolong pregnancy for 48 hours allows: • Betamethasone treatment • Transfer of mother to appropriate neonatal centre for delivery of baby

  14. Prolongation of Pregnancy • Contraindications for continuing pregnancy • Gestational hypertension with proteinuria / adverse events for mother • Chorioamnionitis • Mature fetus • Imminent delivery • Intrauterine death or lethal fetal anomaly

  15. Betamethasone treatment • Dose: 12 mg IM for 2 doses, 24 hours apart • Requires 48 hours for maximum benefit • Gestational age: 24 to 34 weeks • Crosses placenta and accelerates lung maturity • Helps prevent intra-ventricular hemorrhage and necrotizing enterocolitis

  16. Antenatal Steroid Cautions • If immediate delivery indicated, do not delay for steroid effect • If cardiac disease, active TB, chorioamnionitis, placental abruption • Transient increase in WBC count

  17. Tocolytics • Some evidence for: • Nifedipine (Calcium Channel blocker) • Indomethacin (Prostaglandin Synthetase Inhibitor) • Gestational age <32 weeks • Risk of fetal premature closure of ductus arteriosis • 100 mg suppository PR for transport

  18. Maternal Transport • Mother should be transported to hospital best suited for delivery of neonate • Requires transportation with skilled birth attendant • Consider risk of delivery en route • Consider risk of journey to maternal / neonatal well-being

  19. Maternal Transportation • Contraindications • Unstable mother • Abnormal fetal monitoring • Imminent delivery • Lack of skilled birth attendant to accompany mother • Weather or hazardous conditions for travel

  20. Prevention • Screen & treat for asymptomatic bacteriuria • Screen & treat for STI’s • Education of patients for signs & symptoms of Preterm labor

  21. Conclusion • Diagnosis preterm labor early to provide for appropriate intervention and treatment • Treat with betamethasone if appropriate to enhance fetal lung maturity • Use tocolysis to allow for betamethasone to work and allow for maternal transfer to appropriate hospital

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