PREVENTION & MANAGEMENT OF PRETERM LABOUR

STEP 1: PATIENT PRESENTS

Symptoms: Regular contractions / Abdominal pain / Leaking per vaginum / Backache.
Gestational Age: 20w – 36w 6d

STEP 2: INITIAL ASSESSMENT

·         Sterile Speculum Exam (Always BEFORE Digital Exam)

o    Check for pooling of liquor → ? PPROM

o    Swab for HVS/GBS if indicated.

·         Digital Exam (if no ROM)

o    Cervical dilation ≥2 cm or effacement ≥80%?

·         Ultrasound

o    Confirm gestational age, presentation, AFV.

STEP 3: DIAGNOSIS CONFIRMED

YES, to BOTH:

1.    Regular contractions (4 in 20 min or 8 in 60 min)

2.    Progressive cervical change

 STEP 4: INTERVENTIONS (By Gestational Age)

22w – 23w 6d

·         Counselling: Peri viable, discuss risks/comfort care.

·         Tocolysis: NOT recommended (relative contraindication).

·         Steroids: NOT recommended (by most guidelines).

24w – 33w 6d (FULL INTERVENTION ZONE)

·         Corticosteroids: YES (Betamethasone 12 mg IM x2, 24h apart).

·         Magnesium Sulfate: YES if <32w (4g IV load + 1g/hr).

·         Tocolysis: YES (Nifedipine 20mg PO load) to allow steroids/transfer.

·         Antibiotics: Only for GBS+ or PPROM.

34w – 36w 6d

·         Corticosteroids: Consider (Betamethasone 12mg IM x2) if no prior dose and high risk.

·         Magnesium Sulfate: NO (benefit not established).

·         Tocolysis: Consider short-term for transfer only.

·         Antibiotics: Only for GBS+ or PPROM.

STEP 5: SPECIAL SCENARIOS

🚩 Preterm Premature Rupture of Membranes (PPROM)

·         Antibiotics: Erythromycin 250mg PO QID x 10 days.

·         Steroids: As per GA (up to 33+6).

·         Tocolysis: AVOID (increases chorioamnionitis risk).

·         MgSO4: If <32w.

·         Management: Expectant until 37w if no infection.

🚩 Short Cervix (<25mm on USG)

·         History of prior PTB?

o    Yes: Consider Cerclage or Vaginal Progesterone.

o    No: Vaginal Progesterone 200mg nightly.

STEP 6: DELIVERY & IMMEDIATE CARE

·         Inform Paediatrician/NICU immediately.

·         Delay Cord Clamping: 30–60 seconds (if baby stable).

·         Mode: Based on presentation; cautious with instrumental in very preterm.

CONTRAINDICATIONS TO TOCOLYSIS

❌ Chorioamnionitis (fever, tachycardia, uterine tenderness)
❌ Severe Preeclampsia / Eclampsia
❌ Placental Abruption
❌ Non-reassuring Fetal Status
❌ Lethal Fetal Anomaly