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09-Nov-2007, 20:26
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Preterm LabourPreterm labour Preterm labour, also known as premature labour, is described as the presence of contractions of sufficient strength and frequency to effect progressive effacement and dilation of the cervix between 22 and 37 weeks' gestation. Infants born as a result of preterm labour are at significant risk of morbidity as a result of immaturity. Accurate diagnosis of pre-term labour can allow for the prevention or delay of preterm birth where possible, and where this is not possible, earlier provision can be made to provide optimal support for the immature infant. Just under 7% of UK births are preterm. Less than one-quarter of these are under 32 weeks gestation. Diagnosis of preterm labour The diagnosis of preterm labour can be quite subtle in the first instance and is open to interpretation. For the diagnosis of preterm labour, there should be:
Preterm prelabour rupture of the membranes (PPROM) This occurs in more than one-third of preterm labours. Most women so affected will deliver within 1 week. PPROM is often associated with maternal infection (Medforth, Battersiby, Evans, Marsh and Walker, 2006). Risk factors Disease or infection in the woman or baby (i.e. malaria, GBS, HIV). Pre-eclampsia, eclampsia. Antepartum Haemorrhage, Placental Abruption, Placenta Praevia. Intrauterine growth retardation PPROM. Intrauterine death. Multiple pregnancy. Polyhydramnios. Cervical incompetence (may be a result of cervical surgery or surgical termination of a pregnancy). Previous preterm labour (in selected cases, a cervical suture may have been placed to reduce the risk of a second preterm delivery). Congenital abnormalities. Maternal stress. Heavy physical work. Maternal age <15. Smoking. Low social class. Unsupported and/or unmarried mothers. Complications of preterm labour: Major problems occur for babies born after 24 weeks (when the baby is viable) and before 33 weeks’ gestation. Fetal death may occur as a result of intraventricular haemorrhage (bleeding in the brain), respiratory distress syndrome (RDS), infection, jaundice, hypoglycaemia, or necrotising endocolitis. In cases of PPROM, survival rates are linked to the gestation at membrane rupture, rather than duration of rupture. There is a high risk of chorio-amnionitis. The prognosis depends on the antenatal administration of steroids to the mother, the gestation and birth weight, condition at birth, and the immediate care after birth, including the availability of a neonatal intensive care unit (NICU). Medforth, J., Battersby, S., Evans, M., Marsh, B. and Walker, A. (2006) Oxford Handbook of Midwifery. Oxford: Oxford University Press. Local Trust Policy (2003) Regional Guideline for the Management of Preterm Labour. http://www.patient.co.uk/showdoc/40000202/ Books      |
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23-Nov-2007, 10:33
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 Re: Preterm Labour * Checked as accurate - K(RM)
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