Preterm delivery

1. Big picture

Preterm delivery means birth before fetal maturity is complete, classically before 37 completed weeks of gestation. It is one of the most important obstetric topics because it is a major cause of perinatal mortality, neonatal respiratory distress syndrome, intraventricular haemorrhage, necrotizing enterocolitis, sepsis, long-term neurodevelopmental impairment, and cerebral palsy.

For the oral exam, think in this order:

Threatened preterm birth
        ↓
Confirm gestational age and viability
        ↓
Is labour true or false?
        ↓
Are membranes intact or ruptured?
        ↓
Is there infection, bleeding, fetal compromise, or maternal danger?
        ↓
If safe, delay birth briefly to give corticosteroids, magnesium sulfate, antibiotics when indicated, and transfer to neonatal center
        ↓
If unsafe to continue pregnancy, deliver

The key exam idea is:

In preterm labour, tocolysis is not the treatment that improves the neonate directly. Its purpose is usually to gain about 48 hours for antenatal corticosteroids, magnesium sulfate if indicated, and in-utero transfer to a tertiary neonatal unit. ACOG describes tocolysis as short-term prolongation that allows steroids, magnesium sulfate, and transfer when needed. ([LWW Journals][1])

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