Pharmapedia Pro
Back to Ward Guide
Gynecologic and Obstetric Disorders

Premature Labour

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

Clinical features

Cervical changes (effacement and dilatation) and regular uterine contractions before 37 weeks LMP. Metrorrhagia are not always present in premature labor. If present blood loss is usually minimal. Preterm regular uterine contractions approximately 5 minutes apart. Cervical dilatation, effacement, or both.

Management

  • Advice Strict bed rest.
  • Allow labor to progress in the following cases: gestation is more than 37 weeks; the cervix is more than 3-4 cm dilated; there is significant bleeding; the fetus is distressed or dead; there is amnionitis or pre - eclampsia.
  • Otherwise, tocolysis: O Give, Cap- Adalat (nifedipine) 10mg, 1 cap PO x stat, to be repeated every 15 minutes if uterine contractions persist (maximum 4 doses or 40 mg), then 20 mg every 6 hours for 48 hours.
  • Do not administer by sublingual route (risk placental hypo perfusion, foetal death), always by oral route or, if not available, give inf- Salbutamol (Albuterol) 5mg (10 ampoules of 0.5 mg) in 500 ml of 5 % glucose or 0.9 % sodium chloride to obtain a solution of 10 micrograms / ml for 48 hours maximum. Start infusion at the rate of 15 to 20 micrograms / minute (30 to 40 drops / minute). Do not combine nifedipine and salbutamol.
  • If contractions persist, increase the rate by 10 to 20 drops / minute every 30 minutes until uterine contractions not exceed 45 micrograms / minute (90 drops / minute). Continue for one hour after contractions have ceased, then reduce the rate by half every 6 hours.
  • Monitor maternal pulse regularly. decrease the infusion rate in the event of maternal tachycardia (> 120 / minute).
  • If tocolysis is effective and contractions cease or diminish, both cases, do not prolong treatment over 48 hours. Bed re until the end of pregnancy
  • If tocolysis is not effective, contractions persist and labor begin When to Refer, take necessary steps for a premature birth.

When to Refer

  • Symptoms of increased pelvic pressure or cramping in high - risk patients.
  • Regular uterine contractions.
  • Rupture of membranes.
  • Vaginal bleeding.

When to Admit

  • Cervical dilation of 2 cm or more before 34 weeks ' gestation.
  • Contractions that cause cervical change.
  • Rupture of membranes.