An important side effect is that Ritodrine may cause pulmonary oedema.
- Premature Labour is defined as labour occurring between 24 weeks and 37 weeks of gestation.
- The major morbidity is seen with deliveries before 28 weeks.
- Deliveries after 32 weeks have lower levels of morbidity.
- Premature Labour carries with it an x100 fold increased risk of infant death as well as neonatal mortality and long term handicap.
- Low BMI, Smokers
- Low socioeconomic class
- Domestic violence
- Tocolytic agents (these are agents which suppress contractions) which are usually β-mimetic agents are often given but there is no evidence that they change the outcome.
- They may buy time to give steroids and transfer patients to a specialised centre.
- Antibiotics are given prophylactically to those with ruptured membranes to prevent infection.
- Some of those infants who survive go on to display signs of cerebral palsy and chronic lung disease. They may also have learning difficulties and hearing/sight problems.
- Β-Agonists such as Ritodrine, Salbutamol [US Albuterol] and Terbutaline are given iv. These agents reduce smooth muscle contraction.
- Delivery tends to be by Caesarean but there is no evidence that it is safer than vaginal delivery
- Intrauterine Sepsis
- Placental Abruption
- Elective delivery for preeclampsia, haemorrhage, fetal compromise
- Cervical incompetence due to previous cervical surgery or a congenital abnormality. In some cases, a cervical suture can be inserted and then removed at 37 weeks.
- Where the os is closed and the cervix not dilated transvaginal ultrasound to measure the length of the cervical canal is prognostically useful
- Liaison with the paediatric team is vital to help ensure resuscitation and transfer to a specialist unit as appropriate.
- Corticosteroids should be administered to the mother as two im injections 12 hours apart - this reduces the risk of respiratory distress syndrome by increasing fetal production of pulmonary surfactant. Steroids also significantly reduce risk of intraventricular haemorrhage, necrotising enterocolitis and early neonatal death