Table of Contents
Page created on January 4, 2022. Last updated on December 18, 2024 at 16:57
Definition and epidemiology
Threatened preterm delivery is a vague term used to define a situation where preterm delivery may be imminent, requiring the need for management to try to postpone delivery as long as possible. The most common finding which raises alarms for threatened preterm delivery is regular contractions ahead of week 37.
Past gestational week 34, there is no need to attempt to delay premature labour, as the perinatal outcome is so good at that point that applying the measures used to delay labour are no longer justified.
Only a minority of women who present with threatened preterm delivery progress to actual labour and delivery. However, if preterm prelabour rupture of membranes (PPROM) (topic A6) occurs, labour is inevitable.
Etiology
Risk factors:
- History of preterm birth
- Cervical insufficiency
- Multiple gestation
- Genital infection
- Smoking
Clinical features
The following may be signs of threatened preterm labour:
- Regular, painful uterine contractions less than 10 minutes apart lasting more than 1 hour (most common)
- Other symptoms of labour (lower back pain, blood-tinged vaginal mucus)
- Cervical dilation or effacement
Diagnosis and evaluation
If there are signs of a possible threatened preterm delivery, we must determine whether this is a false alarm or whether preterm delivery truly is inevitable. The following findings suggest preterm labour is likely (their absence suggest it’s unlikely):
- Cervix dilated > 3 cm (and cervical dilation increases over time)
- Cervical length < 20 mm
- Foetal fibronectin level is positive
Foetal fibronectin is a protein which is released into cervicovaginal secretions in case of true preterm labour. It may be measured to distinguish women in true preterm labour from those in false labour.
Treatment
In case preterm delivery may be imminent, glucocorticoids (betamethasone or dexamethasone) are administered IM to the mother in two doses, the second dose repeated 24 hours after the first. Glucocorticoids hasten maturation of the foetal lungs (by stimulating surfactant production), reducing the incidence of neonatal respiratory distress syndrome (NRDS) as well as perinatal morbidity and mortality in general. This effect occurs as early as a few hours after the first dose, but the maximum effect is not achieved until 24 hours after the second dose. The effect lasts approximately 7 days.
Tocolytics (beta mimetics, atosiban, nifedipine) may be used to delay labour for a few days, allowing the glucocorticoids to take effect.
Magnesium sulphate administration is neuroprotective and reduces the risk of cerebral paresis in case of preterm birth. It’s recommended in case of threatening preterm labour.
Antibiotics (penicillin, ampicillin) may be administered to reduce the risk for GBS infection.
Complications
Possible complications of preterm birth include:
- Neonatal respiratory distress syndrome (NRDS)
- Bronchopulmonary dysplasia
- Necrotising enterocolitis
- Retinopathy of prematurity
- Periventricular leukomalacia
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I don’t know if this is important for our department but we can also do some preventative measures if the woman has a history of preterm birth or cervical incompetence.
PV Progesterone: decreases the risk of preterm birth by 50% in women with a short cervix, and reduces the recurrence in women who have a history of preterm delivery.
Cervical Sutures (cerclage): can potentially be used as a rescue treatment in response to a women with cervical dilation or as a prevention to those with a short cervix (at least thats how it was used in Ireland)
my source is my consultant during my practice which is less than optimal for helping you include it in the notes but if you wanna verify the info I think it could be useful. Sorry I’m too lazy to verify
Both of these are explained in B20