Summary This is an article that discusses the basics of preterm labour.

Basics

Preterm labour occurs when the patient develops regular painful contractions (3 per 10 minutes), occurring < 37 weeks of gestation.

Management

Refer with tocolysis and corticosteroids
Assess fetal well being
Estimate fetal weight
Prepare for the delivery of a preterm neonate.
To improve lung maturity:
1. Betamethasone 12mg 12 hourly (2 doses) IM. Take note that there are several ways of prescribing this. Some prefer 12mg 24 hourly (2 doses). If Betamethasone is not available, then you may use Dexamethasone 8mg IM 8 hourly (for 3 doses).
2. Benefits of antenatal corticosteroids reduces mortality, respiratory distress syndrome, intraventricular haemorrhage, and necrotizing enterocolitis.
3. Corticosteroids are maximally effective from 24 hours of administration.
To tocolyses:
1. Preload with sodium chloride 0.9% 200ml IV then tocolyses with
2. Nifedipine 20mg as a single dose PO, followed with 10mg after 30mins if the contractions persist. Then 10mg every 4 hours until the patient is transferred to a higher level of care. Maximum duration that this can be given is 24 hours.
3. If the gestation < 32 weeks of gestation and nifedipine contraindicated: Indomethacin 50mg PO immediately then 25mg 4 hourly for up to 48 hours. It is important to be made aware that indomethacin may cause oligohydramnios and it is associated with premature closure of the ductus arteriosus.
Antibiotics are not routinely used.

Allow labour to continue at a midwife obstetrics unit, otherwise, all cases should be referred.

Published on November 7, 2022

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