Preterm Labour in Pregnancy and Complications

Preterm labor

Preterm labour is defined as babies born alive before 37 weeks of pregnancy completed.

EXTREMELY PRETERM   : < 28 weeks 

VERY PRETERM  : 28 to < 32 weeks

MODERATE TO LATE PRETERM : 32 to < 37 weeks

Induction or caesarian birth should not be planned before 39 weeks completed unless medically indicated 

Gestational age Versus Birth weight
Low birth weight  (<2500 g)
Very low birth weight (<1500 g)
Extreme low birth weight (<1000 g)
Only two third of low birth weight infants are preterm.
Term infants may be low birth weight because they are small for gestational age

Preterm birth complications are the leading cause of the death among children under 5 years of age, responsible for nearly 1 million death in 2013.
Total incidence is 5-10%
Complication of preterm birth :

Neonatal death                                
  Necrotizing entero-colitis
 Retinopathy of prematurity

Risk factors 

HISTORY plays a role in PTL

H/O preterm delivery or spontaneous abortion

Pregnancy following ART (IUI, ICSI)

Asymptomatic bacteuria / recurrent UTI

Smoking habits / Maternal stress/ low socio economic and nutritional stress

Risk Factors



 Seen in majority cases where premature effacement of the cervix with irritable uterus and early engagement of the head is often associated.

Antepartum hemorrhage
Premature rupture of membranes

 Cervical incompetence
 Malformation of uterus 
 Medical and surgical illness : Acute fever, polynephritis, acute  appendicitis,  diabetes, decompensated heart lesion, severe anemia  low body mass index

Genital tract infection: Bacterial vaginosis, beta hemolytic streptococcus,   chlamydia

 Congenital malformation, Intrauterine death

 Infarction, Thrombosis, Placenta pervia


Signs and symptoms

Regular uterine contraction every 10 mins or more
Fluid leaking from vagina
Cramping in lower abdomen
Increased vaginal bleeding
Increased pressure in pelvis
Vaginal spotting

Prediction of Preterm Labour

  1. Assesment of risk factors
  2. Vaginal examination to assess the cervical status
  3. Ultrasound visualization of cervical length and dilatation 
  4. Detection of fetal fibronectin in cervical vaginal secretion

Diagnosis of Preterm Labour

Regular uterine contraction with or without pain(atleast one in  every 10mins)
Dilatation (≥ 2cm)
Effacement (80%)
Length of cervix ≤ 2.5cm (TVS)
Funnelling of the internal OS
Pelvic pressure / back ache/ vaginal discharge or bleeding

Prevention of Preterm labor

Primary care: Reduce the incidence of PTL by reduce the risk factors 

Secondary symptoms : Include screening test for early detection and prophylactic treatment (tocolytics)

Tertiary care: To reduce perinatal morbidity and mortality  after the diagnosis (use of corticosteroids)

Seeking of regular prenatal care
Healthy diet and gaining weight nicely
Limiting certain physical activities
Managing chronic conditions like diabetes,  increased HTN

Arresting preterm labor

Bed rest in left lateral position
Adequate hydration
Prophylactic antibiotics
Tocolytic agents (eg. Terabutaline, indomethacin, nifedipine)

Short term / long term


Short term therapy
Most succesful therapy

 1. Delay delivery for 48 hrs for GLUCOCORTICOID THERAPY to mother to enhance fetal lung maturation.

  2. In utero transferof the patient to a unit more able to manage a preterm neonate

Glucocorticoid therapy 

Recommended in pregnancy less than 34 weeks 
Helps fetal lung maturation
Reduces the incidence of RDS and IVH


Prelabor rupture of membrane  with evidence of infection
IDDM patient needs readjustment of their insulin  dose


To prevent birth asphyxia and development of RDS
To prevent birth trauma

First stage

Patient is put to bed to prevent PROM
To provide adequate fetal oxygenation
Strong sedative avoided
Epidural anesthesis is of choice
Labour should be watched by intensive clinical monitoring
In case of delay LSCS should be performed


Birth should be gentle and slow to avoid rapid compression and decompression of head
Episiotomy may be done by LA to minimize the head decompression if there is perineal resistance
Tendency to delay is curtailed  by low foreceps. Routine forceps is not indicated
The cord has to be clamped immediately at birth to prevent hypervolemia and hyperbilurubinemia
Shift the baby to NICU under the care of neonatalogist


The cord is to be clamped quickly
Cord length is kept long in case of exchange transfusion is required 
Air passage should be cleared of mucus
Adequate oxygenation
Aquaeous solution of vit K 1mg is given IM to prevent hemorrhagic manifestations
Baby should be wraped including head in a sterile warm towel

Points to be noted 

Assess the mother condition to evaluate the signs of labor 
    Obtain a thorough obstetrics history
    Determine the frequency, duration, and intensity of uterine contractions
    Determine the cervical dilatation and effacement
Perform measure to stop or manage preterm labor
Bed rest in a side-lying position
Prepare for tocolytic therapy
Asses for the side effect of tocolytic therapy:
Decreased maternal bp
Chest pain 
FHR >180bpm
Provide physical and emotional support
Provide adequate hydration
Provide client and family education

Prognosis of preterm labour

With NICU survival rate of baby weighing b/w 1000 to 1500gm is more than 90%
With the use of surfactant, survival rate of infant  born at 26wks is about 80%

Pulmonary surfactant is essential for life as it lines the alveoli to lower surface tension, thereby preventing atelectasis during breathing.

If a baby is premature (born before 37 weeks of pregnancy), he or she may not have made enough surfactant yet. When there is not enough surfactant, the tiny alveoli collapse with each breath. As the alveoli collapse, damaged cells collect in the airways. They further affect breathing.

Egg Freezing Cost

ICSI Treatment

Fertility Enhancing Surgery

Repeated Pregnancy Loss

Embryo Freezing