Predictors, Treatment and Prevention of Preterm Labour: A Review

Abstract

Preterm labour (PTL) is one of the leading causes of neonatal morbidity and mortality throughout the world. It is also a major public health problem for its long-term disabilities like cerebral palsy and visual disturbance. Preterm labour is a multifactorial problem and its overall global incidence is 11.1 per 100 live births with a significant regional variation. About 45-50% of preterm deliveries are spontaneous, 30% are associated with preterm prelabour rupture of membranes (PPROM) and another 15-25% is induced for maternal and/or foetal risk. Previous history of PTL is an important risk factor; risk is 14.3% after one preterm birth and 28% after two preterm births. Other important risk factors are multiple pregnancy, polyhydramnios, bicornuate uterus, cervical incompetence & bacterial vaginosis. Prediction of PTL is very difficult but identification of risk factors, assessment of cervical length by ultrasonography and detection of foetal fibronectin in cervical secretions are of great help. Advanced cervical dilatation (>3 cm) or PPROM associated with sufficient and frequent uterine contractions confirm the diagnosis of preterm labour. Prevention of PTL has been tried with prophylactic cervical cerclage, antibiotics and progesterone. PTL is treated with various tocolytic agents and glucucorticoids and antibiotics for local or systemic infection. Betamimetics, calcium channel blockers (nifedipine), prostaglandin synthesis inhibitors and magnesium sulfate are the commonly used tocolytics. Nifedipine has significantly fewer maternal adverse effects than betamimetics and magnesium sulphate. Antenatal corticosteroid treatment has been found to lower neonatal mortality, the risk of neonatal respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis. The ultimate goal of prevention and management of preterm labour is to improve neonatal outcome and to reduce morbidity and mortality.

Journal of Science Foundation, July 2017;15(2):57-63