Threatened premature labour
EBM Guidelines
Sep 5, 2023 • Completely updated
Table of contents
Extract
- Signs of beginning labour
- Regular, painful uterine contractions 10 minutes or less apart for > 1 h
- Recurrent or significant bloody discharge or discharge containing blood and mucus
- Suspected preterm premature rupture of membranes (PPROM)
- Cervical ripening
- Drug therapy
- Tocolysis with nifedipine will delay delivery slightly to gain time for
- glucocorticoids to mature the foetal lungs
- magnesium sulphate to reduce the risk of cerebral palsy.
- Tocolysis with nifedipine will delay delivery slightly to gain time for
- Glucocorticoids should be given until week 34+6 of pregnancy; subsequently, delivery should no longer be prevented.
- A gynaecologist should be consulted.
- If the membranes have ruptured, the mother should be transported to hospital in a supine position to avoid umbilical cord prolapse.
Linked evidence summaries
- Antibiotic administration following preterm rupture of membranes (less than 37 weeks) is associated with a delay in delivery and a reduction in neonatal and maternal morbidity.A
- A course of antenatal corticosteroids to the mother accelerates fetal lung maturation in women at risk of preterm birth and reduces the risk of neonatal death, respiratory distress syndrome and several other complications.A
- Calcium channel blockers (nifedipine) are effective for inhibiting preterm labour compared with placebo or no treatment. They appear to be as effective as oxytocin receptor antagonist atosiban with lower costs.A
- Oxytocin receptor antagonists (atosiban) are effective for inhibiting preterm labour compared with placebo or no treatment. They appear to be as effective as calcium channel blockers (nifedipine) but with higher costs.A
- Antenatal magnesium sulphate therapy for women at risk of preterm birth is effective for reducing the risk of cerebral palsy in the child.A
- Dexamethasone and betamethasone appear to be as effective for foetal lung maturation for women at risk of preterm birth.B
Search terms
Betamethasone, Cervix Uteri, Fetus, Glucocorticoids, Hydroxycorticosteroids, O42*, O47.0, O60* , O80, O80-O84, Obstetrics, PPROM, Parturition, Pregnancy, Premature Birth, Transportation, cervix, lung maturation, premature uterine contractions, prophylaxis, threatened premature labor, water break