Preterm Labor & delivery

Pre Term Labor and Delivery in Jaipur

Preterm labor (PTL) is defined as one where the labor starts after the 20th week and before the 37th completed week of pregnancy. Preterm birth is the significant cause of perinatal morbidity and mortality.

What are the causes?

In about 50%, the cause of preterm labor is not known. Often it is multifactorial. The following are, however, related with increased incidence of preterm labor :

• Previous history of abortions or preterm delivery;
• Pregnancy following assisted reproductive techniques (ART);
• Recurrent urinary tract infection;
• Smoking habits
• Low socioeconomic and nutritional status
• Maternal stress.
• Complications in present pregnancy like preeclampsia, antepartum hemorrhage, premature rupture of the membranes, polyhydramnios.
• Uterine anomalies like short cervix, malformation of uterus
• Medical and surgical illness like Acute fever,diarrhea, acute appendicitis, abdominal operation.
• Chronic diseases like hypertension, diabetes, severe anemia, low body mass index.
• Multiple pregnancy, congenital malformations of fetus and intrauterine death.
• Placental Infarction, thrombosis, placenta previa or abruption.

How is this diagnosed in Jaipur at Dr Mayuri Gynecology Clinic?

The only subjective symptom is regular uterine contractions. apart from that the doctor diagnoses by cervical examination, transvaginal ultrasonography and/or fibronectin test (Presence of fibronectin in the cervicovaginal discharge between 24 weeks and 34 weeks is a predictor of preterm labor).

How is pre term labor managed?

Prevention of the onset of PTL or arrest of labor are the first line of managements, if delivery is the only option then the following things are done :

• Glucocorticoids to the mother
• Antenatal transfer of the mother with fetus in utero to a tertiary center equipped with NICU
• Tocolytic drugs to the mother for a short period unless contraindicated
• Antibiotics to prevent neonatal infection
• Magnesium sulfate (neuroprotector) to the mother to reduce neonatal cerebral palsy when pregnancy is <34 weeks.
• Careful intrapartum monitoring, minimal trauma and presence of a neonatologist during delivery
• Vaginal delivery is preferred, unless otherwise indicated for cesarean birth

Can PTL be prevented?

In 50% cases the cause is unknown so prevention is based on the risk factors :

• Reduce the incidence of preterm labor by reducing the high-risk factors (e.g. infection, etc.).
• Screening tests for early detection and prophylactic treatment (e.g. tocolytics).
• Reduce the perinatal morbidity and mortality after the diagnosis (e.g. use of corticosteroids).
• Investigations: Full blood count; Urine for routine analysis, culture and sensitivity; Cervicovaginal swab for culture and fibronectin; Ultrasonography for fetal well being, cervical length and placental localization and Serum electrolytes and glucose levels when tocolytic agents are to be used.