Treatment requires correct diagnosis of establishment of preterm labor.
Corner stone of management of preterm labor is to avoid delivery prior to 34 weeks if possible.
Tocolytics can be used to halt uterine contractions and steroids to reduce perinatal morbidity.
Amniocentesis can be done to diagnose intra amniotic infection , but it has not been shown to be associated with improved pregnancy outcomes in women with or without membrane rupture.
Glucocorticoid therapy to enhance fetal lung maturity: Steroids, betamethasone and dexamethasone are effective in preventing respiratory distress and neonatal mortality if birth was delayed for at least 24 hrs after initiation of therapy.
Its effect persisted for upto 7 days after completion of steroid therapy.
Recommended regimens :
A single course of two doses 12 mg of betamethasone given intramuscularly 24 hrs apart or 4 doses of 6 mg dexamethasone given intramuscularly 12 hours apart.
Steroids also decrease the risk of intra ventricular hemorrhage and neonatal mortality.
Multiple maternal doses of dexamethasone is associated with increased risk of leucomalacia and neurodevelopmental abnormalities.
Though betamethasone is better than dexamethasone, multiple doses are associated with early onset neonatal sepsis, chorioamnionitis, neonatal death, IUGR.
Short term maternal adverse effects include pulmonary edema, infection and more difficult glucose control in diabetic women.
No longterm adverse effects reported.
Thyrotropin releasing hormone for fetal lung maturity:
T3 enhances surfactant synthesis. But TRH(thyrotropin releasing hormone) administration unchanged the neonatal lung synthesis.
Phenobarbital and vit-k may reduce neonatal intracranial hemorrhage but it is not proved.
Tocolytics:
These are the drugs used to prevent premature births and to prolong pregnancy.
But the overall incidence of preterm labor before 34 wks has not been found to be reduced with the use of tocolytics.
The end points of various studies has taken as cessation of contractions for 24hrs, 48hrs and 7days.
Meta analysis of randomized trials have shown that tocolytics reduce the risk of delivery within 24hrs and 48hrs.
The major advantages of tocolytics are possibility of administering steroid therapy.
And in utero transfer for better neonatal outcome.
Preterm labor-etiologicalfactors
Preterm labor-pathogenesis and diagnosis
Preterm labor-investigations
Preterm labor-prediction
Preterm labor-complications
Preterm labor -prevention
Preterm labor-bacterialvaginosis
Preterm labor-progesterone.html
Preterm labor-cervical circlage
Pretem labor-management
Preterm labor-tocolytics
Preterm labor-with premature rupture of membranes
Corner stone of management of preterm labor is to avoid delivery prior to 34 weeks if possible.
Tocolytics can be used to halt uterine contractions and steroids to reduce perinatal morbidity.
Amniocentesis can be done to diagnose intra amniotic infection , but it has not been shown to be associated with improved pregnancy outcomes in women with or without membrane rupture.
Glucocorticoid therapy to enhance fetal lung maturity: Steroids, betamethasone and dexamethasone are effective in preventing respiratory distress and neonatal mortality if birth was delayed for at least 24 hrs after initiation of therapy.
Its effect persisted for upto 7 days after completion of steroid therapy.
Recommended regimens :
A single course of two doses 12 mg of betamethasone given intramuscularly 24 hrs apart or 4 doses of 6 mg dexamethasone given intramuscularly 12 hours apart.
Steroids also decrease the risk of intra ventricular hemorrhage and neonatal mortality.
Multiple maternal doses of dexamethasone is associated with increased risk of leucomalacia and neurodevelopmental abnormalities.
Though betamethasone is better than dexamethasone, multiple doses are associated with early onset neonatal sepsis, chorioamnionitis, neonatal death, IUGR.
Short term maternal adverse effects include pulmonary edema, infection and more difficult glucose control in diabetic women.
No longterm adverse effects reported.
Thyrotropin releasing hormone for fetal lung maturity:
T3 enhances surfactant synthesis. But TRH(thyrotropin releasing hormone) administration unchanged the neonatal lung synthesis.
Phenobarbital and vit-k may reduce neonatal intracranial hemorrhage but it is not proved.
Tocolytics:
These are the drugs used to prevent premature births and to prolong pregnancy.
But the overall incidence of preterm labor before 34 wks has not been found to be reduced with the use of tocolytics.
The end points of various studies has taken as cessation of contractions for 24hrs, 48hrs and 7days.
Meta analysis of randomized trials have shown that tocolytics reduce the risk of delivery within 24hrs and 48hrs.
The major advantages of tocolytics are possibility of administering steroid therapy.
And in utero transfer for better neonatal outcome.
Preterm labor-etiologicalfactors
Preterm labor-pathogenesis and diagnosis
Preterm labor-investigations
Preterm labor-prediction
Preterm labor-complications
Preterm labor -prevention
Preterm labor-bacterialvaginosis
Preterm labor-progesterone.html
Preterm labor-cervical circlage
Pretem labor-management
Preterm labor-tocolytics
Preterm labor-with premature rupture of membranes
No comments:
Post a Comment