Preterm Labour management our protocol

Preterm delivery considerably contributes to adverse perinatal outcomes and effective measures for prediction, prevention and amelioration are still desired. Much of this adverse outcome can be reduced by effective diagnosis and management of threatened preterm labour. Appropriate treatment protocol in the management of threatened preterm labour can help in improving the outcomes. Threatened preterm labor is defined as regular uterine contractions occurring at the frequency of at least 1 time in 10 minutes with no effacement and dilatation of cervix between 20-37 weeks. The examination was taken for at least 30 minutes. We have devised a protocol based on the available research and is under validation for effectivity. The patient is admitted for inpatient care and offered magnesium sulphate 4G intravenously.2G magnesium sulphate is repeated after 2 hours intramuscularly if necessary. Nifedepine 20 mg slow release formulation is administered and continued 12 hourly for 72 hours .If necessary more 10mg doses are added. High Vaginal Swab is taken for culture and sensitivity  and antimicrobials such as Cefixime 200 mg bid and secnidazole 1 G is given. Dexamethasone 6mg 6 hourly 4 doses are given. Natural progesterone in the dose of 200mg daily vaginally is started and continues till 37 weeks. Recently we have offered our patients the bedside test which evaluates placental alpha microglobulin-1 (PAMG-1) test to predict time to delivery and found it effective. Urinary tract infections and anaemia were significantly associated with preterm delivery in our study group. Syndromic approach in management of threatened preterm labour helps in better outcomes. Magnesium sulphate was found to be effective for tocolysis

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