Makindo Medical Notes.com

An important side effect is that Ritodrine may cause pulmonary oedema.

About

• 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.

Aetiology

• Premature Labour carries with it an x100 fold increased risk of infant death as well as neonatal mortality and long-term handicap.

Risk Factors

• Low BMI, Smokers
• Low socioeconomic class
• Domestic violence
• Afro-Caribbean

Premature Labour

• 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

Causes

• 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.

Management

• 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