Delaying an untimely delivery (original) (raw)

Preterm Birth: Risk Factors, Identification and Management

2017

Preterm birth (PTB) is defined as birth before 37 completed weeks of gestation. Spontaneous preterm labour is the precursor of one third of all PTB, a further third following preterm premature rupture of membranes and the rest being medically indicated.

The aetiology of preterm labour

BJOG: An International Journal of Obstetrics and Gynaecology, 1986

Factors associated with spontaneous preterm birth were analysed in 254 primigravidae who gave birth to singleton infants between 28 and 36 completed weeks gestation in Aberdeen City District between 1978 and 1982. In 144 women labour followed premature rupture of the membranes and in 110 the membranes were intact and labour began with contractions. Among those with intact membranes, unmarried women and teenagers were over represented to a significant extent compared with all primigravidae. Among those with premature rupture of the membranes, the distribution of age and marital state was similar to that in all primigravidae, but the birthweight centile distribution showed a significant shift towards light-for-dates babies. It is argued that there may be two distinct categories of pregnancies that end in spontaneous preterm labour.

Overview. Preterm labour: mechanisms and management

BMC Pregnancy and Childbirth, 2007

Preterm birth remains a major cause of perinatal mortality and long term handicap in surviving infants. This is one of the most important clinical problems in Europe and across the world. While some preterm births are iatrogenic, associated with severe complications of pregnancy (e.g. hypertensive disorders, antepartum haemorrhage, infection), or the result of multiple pregnancies following assisted reproduction, a high

Preterm labour and prematurity

Obstetrics, Gynaecology & Reproductive Medicine, 2007

Preterm birth occurs as a result of spontaneous preterm labour, in most cases associated with infection/inflammation and preterm pre-labour rupture of membranes. About 1/4 cases are iatrogenic. The incidence of preterm birth continues to increase in both developed and developing countries; most perinatal morbidity and mortality results from preterm births at less than 30 weeks' gestation. The prediction of spontaneous preterm birth has improved significantly, particularly through the use of transvaginal ultrasonography and fetal fibronectin testing. However, preventive measures such as tocolysis, cervical cerclage, progestogen and antibiotics have made little impact on outcome and require further evidence-based evaluation. in day-to-day clinical practice, interventions are often chosen based on personal preference, poor evidence of efficacy and the need to 'do something'. Accurate identification of at-risk women and cautious intervention in an evidence-based manner is advocated with careful consideration of the risks and benefits until further information is available to guide management.

A prospective analysis of etiology and outcome of preterm labor

2007

To identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery. METHOD(S) : In this prospective cohort study conducted over a 8 months period (January to August 2005) 416 antenatal women admitted with threatened preterm labor and in preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed. RESULTS : Incidence of preterm labor was 22% and that of preterm deliveries 20.9% Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly high (P<0.0001) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity. RDS was significantly reduced in those who completed steroid cover (P=0.029). CONCLUSION(S) : There is a high incidence of preterm labor and preterm births in our set up, compared to developed countries. Infection is one important modifiable risk factor which can be curtailed. Prolongation of delivery for 48 hours by giving tocolysis for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.

Preterm Labour

The Professional Medical Journal, 2018

… Background: Spontaneous preterm labor that is labor before 37 weeks of gestation is the main cause of preterm delivery. With increasing gestation the level of Serum magnesium levels decreases. Magnesium inhibits uterine contractions by antagonizing calcium. Hypomagnesaemia also causes hyper excitability of neuromuscular junction bringing in muscle cramps and uterine hyperactivity. Objectives: To determine the mean serum magnesium levels in women presenting with preterm labor. Study Design: Cross Sectional Study. Location and duration of study: Ziauddin University Hospitals, Karachi from 8 th December 2015 to 7 th June 2016. Methodology: Total 40 women of age 18-40 years having singleton pregnancy between 28-36 weeks gestation with established preterm labor having cervical dilatation less than 3cm. were included. 5ml blood was collected and analyzed. Outcome in terms of Mean Standard Deviation were noted. Descriptive statistics were applied. Stratification was done using student t-test and ANOVA where appropriate. The p-value ≤0.05 was considered as significant. Results: The mean age was 26.25±2.38 years. Mean gestational age was 32.77±2.11 weeks. Mean cervical dilatation was 1.85±0.39 cm. Mean serum magnesium level was found 1.43±0.25 mg/ dl. The results showed that there was significant difference in mean serum magnesium level for gestational age but not significant for age, cervical dilatation, parity and gravida. Conclusion: The results showed that serum magnesium level reduced with increased gestational age. Preterm labor can be predicted by serum magnesium levels.