Management of preterm labor

Contextualised By: Chris
Source: http://www.aafp.org/afp/990201ap/593.html

Tocolysis

- offer some short-term benefit in the management of preterm labor.

-A delay in delivery can be used to administer corticosteroids to enhance pulmonary maturity and reduce the severity of fetal respiratory distress syndrome, and to reduce the risk of intraventricular hemorrhage.

-The delay can also be used to facilitate transfer of the patient to a tertiary care center. –

-Tocolytic therapy also has potential for maternal complications. These agents should be used only when the perceived benefits outweigh the risks.

-Contraindications to tocolysis include nonreassuring fetal heart rate tracing, eclampsia or severe preeclampsia, fetal demise (singleton), chorioamnionitis, fetal maturity and maternal hemodynamic instability.


Corticosteroid Therapy

-Dexamethasone and betamethasone are the preferred corticosteroids for antenatal therapy. Corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in infants between 24 and 34 weeks of gestation..

-Maternal pulmonary edema can occur when antenatal corticosteroids are used in combination with tocolytic agents. This complication is more commonly associated with maternal infection, fluid overload and multiple gestation. Pulmonary edema has not been reported when corticosteroids are used alone.

-In women with PPROM, antenatal corticosteroid therapy reduced the risk of respiratory distress syndrome. The magnitude of the reduction in this group is not as great as in women with intact membranes. In women with PPROM at less than 30 to 32 weeks of gestation, in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended because of the high risk of intraventricular hemorrhage at this early gestational age. Although the risk of maternal and fetal infection may increase with corticosteroid use, the increased risk is small.


Antibiotic Therapy

-Group B streptococcal disease continues to be a major cause of illness and death among newborn infants and has been associated with preterm labor, although data supporting this association are weak. A gestational age of less than 37 weeks is one of the major risk factors for group B streptococcal disease.

- Recent data suggest that poor fetal outcome (death, respiratory distress, sepsis, intraventricular hemorrhage or necrotizing colitis) occurred less frequently in women receiving antibiotics (average gestational age: 24 to 32 weeks). In addition, women who received antibiotics sustained pregnancy approximately twice as long as those who did not receive antibiotics and also had a lower incidence of clinical amnionitis.