Preterm labour (PTL)

O60

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

Regular painful contractions: 3 per 10 minutes, occurring < 37 weeks of gestation.

Note: Women with a previous spontaneous preterm delivery are at higher risk for preterm delivery in the next pregnancy. Refer the following high-risk cases for cervical screening:

• A history of 2nd trimester miscarriage (between 16 and 26 weeks).
• Previous history of spontaneous preterm birth between 27 and 34 weeks.
• No need to refer previous late preterm deliveries (34-37 weeks).

LoE:III[30]

GENERAL MEASURES

< 26 weeks:

• Refer without tocolysis (medicines to inhibit uterine contractions).

26–34 weeks of gestation:

• Refer with initial tocolysis and corticosteroids.

>34 weeks gestation:

• Allow labour to continue at midwife obstetric unit.

MEDICINE TREATMENT

To improve fetal lung maturity at 26–34 weeks: Z29.2

• Betamethasone, IM, 12 mg, 2 doses 12 hours apart.

LoEI [31]

Tocolysis: (Z29.2)
Preload with:

• Sodium chloride 0.9%, IV, 200 mL.

THEN

• Nifedipine, oral, 20 mg as a single dose.
  • Follow with 10 mg after 30 minutes, if contractions persist.
  • Then 10 mg every 4 hours until patient is transferred.
  • Maximum duration: 24 hours.

REFERRAL

All cases before 34 weeks.