Preterm delivery

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Preterm delivery (PTD) is defined as a fetus being born to a reproductive female after 20 to 37 completed weeks of pregnancy. Preterm delivery accounts for approximately 5-10% of all births, and can result in handicaps and disability to the newborn or the mother.

Risk factors — as with all obstetrics problems — can be broken down into maternal, fetal, and placental factors.

Maternal factors include a previous preterm delivery, a premature rupture of membranes, second trimester bleeding, socioeconomic factors such as nutrition, smoking, or drugs, and a history of indicated preterm inductions to combat preeclampsia or fetal growth restriction.

Fetal and placental risk factors can be multiple gestations, congentital abnormalies, placental abruption and placenta previa.

Investigations

Ultimately, diagnosis of preterm delivery is retrospective. This is a fancy way of saying that doctors have no idea what the hell is going on, and so can say — post facto — that the delivery was preterm. An attempt to predict preterm delivery is to assess clinical risk scores, biochemical| markers, changing cervix, contractions (or the symptoms of labour) every 5 minutes, or a rupture of membranes.

Management

Patients should be triaged to the appropriate birth unit as quickly as possible, with the arrest of labour used only to facilitate transfer to the aforementioned birth unit. Tocolysis can be used for approximately 48 hours, after which antenatal steroids are used along with antibiotic treatment - namely GBS prophylaxis to prevent neonatal sepsis.

Resources