PC

Preterm labour with intact membranes involves regular painful contraction and cervical dilatation, without rupture of the amniotic sac.

Examination:

• Speculum examination to assess for cervical dilatation.

Investigations

• Less than 30 weeks gestation, clinical assessment alone is enough to offer management of preterm labour.
• More than 30 weeks gestation, a transvaginal ultrasound can be used to assess the cervical length. When the cervical length on ultrasound is less than 15mm, management of preterm labour can be offered. A cervical length of more than 15mm indicates preterm labour is unlikely.

Management

Options:

• Fetal monitoring (CTG or intermittent auscultation)
• Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
• Maternal corticosteroids: can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
• IV magnesium sulphate: can be given before 34 weeks gestation and helps protect the baby’s brain
• Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby at birth