Labour: Threatened Preterm CPG

• Definition

• Assessment

• Investigations

• Management

Definition

Assessment

• Evidence of APH (Placental abruption or praevia)

• Are the membranes intact (Refer to CPG Rupture of the Membranes: Preterm Premature PPROM)
  

• Evidence of chorioamnionitis

• Evidence of maternal systemic infection eg UTI

• Evidence of maternal systemic illness

• Evidence of uterine anomaly

• Evidence of polyhydramnios

• Past obstetric and gynaecological history

Investigations

• Fetal Fibrinectin (fFN)

• FBE

• Cervical, high vaginal, ano-rectal swabs

• Ultrasound scan

• Presentation

• Placentography

• Biometry

• Anomaly

• AFI

• Doppler studies of umbilical artery

• Cervical morphology

Management

• If uterine activity settled, discontinue tocolytic of transfer

• Hourly maternal observations

• IV access with rehydration protocol (3litres Hartmanns over 24 hours)

• Commence continuous Electronic Fetal Monitoring (EFM) if gestational age > 25 weeks

• Consider withholding tocolytics unless uterine activity increases in frequency / severity over the following two hours

• Consider withholding steroids unless uterine activity increases in frequency/severity over the following two hours

• If tocolytics required commence Nifedipine (Refer to CPG Labour: Preterm Tocolysis) continue whilst steroid cover administered
  

• If steroids are required to promote fetal lung maturity; administer Celestone 11.4mg (IM) Daily, X 2 injections, 24 hours apart

• Antibiotics not indicated in the presence of intact membranes and absence of evidence of infection

Subsequent management

• If symptoms of PTL persist for four hours following initial presentation reevaluate the patient including cervical assessment

• If establishing in labour manage as per actual preterm labour