Pre-term Labur:
It is defined as a labour which developes from the viability of the fetus (in the UK 24 weeks of gestation,in Iraq 28 weeks from the date of the LMP) and before completed 37 weeks of gestation.
Incidence:
10% of all deliveries.
Atiology and predisposing factors for PTL:
They found that in 75% of the patients there is no cause.
Spontaneous pre-mature rupture of membrane .
Local infection (chorio-amnionitis) is a cause for PTL in 10-20% of cases .
Previous PTL or late abortion.
Overditended uterus due to multiple pregnancy or polyhydramnios is a predisposing factor
Fetal anomalies: the incidence of fetal anomalies is higher in
pregnancies complicated by PTL.
Management: Diagnosis of pre-term labour History:
Symptoms including criteria of the labour pain.
Predisposing factors.and risk factors.
Complications of pregnancy.
Medical diseases .
On Exam:
General Exam and abd. Exam.
Pelvic exam.: findings related to Bishop score
Regarding cervical dilatation,cervical effacement,position,consistency,and station
Presenting part
Investigations:
.-General urine exam.
-Complete blood picture and blood group and Rh.
-Randum blood sugar.
-Ultrasound: for gestational age, viability ,presenting part,any anomalies,placental localization.
-Fetal fibrinoctin testing
Treatment:
-Admission to hospital with intensive neonatal care.
-Options either continue the labour or conservative treatment.
If we choose continue the labour providing no contraindications for it,our management includes;
First stage of labour ,by partogram regarding progress of labour and fetal heart monitoring.
Second stage of labour :sometimes we can use prophylactic forcps delivery .
Third stage of labour; delivery of the placenta.
Conservative Treatment:
-bed rest.
-tocolytic agents: it s aim to stop uterine contractions