Wednesday, April 1, 2009



What is preterm labor?
Contractions and progressive cervical change between 20-37 completed weeks gestational age.
What is the incidence of preterm labor?
Occurs in 5 % to 15 % of all pregnancies rates have remain unchanged for decades despite efforts to intervene.

An infant is considered premature when it is born before the 37th-38th weeks of gestation. Other criteria of pre-terms are as follows:
Weight :2500 gram or less.
Crown-heel length less than 47 cm.
Circumference of head less than 33 cm.
Circumference of thorax less than 30 cm.
The symptoms and signs of preterm labor: Menstrual like cramps, dull low back pain, abdominal or pelvic pressure, irregular vaginal discharge and irregular uterine contractions.
What constitutes “labor”? Regular uterine contractions with: contractions lasting at least 30 seconds. At least two contractions in 10-minute period; persistent of contraction pattern for at least 30 minutes. Progressive cervical change.
What are the generally accepted values for low-birth-weight neonates?
The weight more than 2500 g = normal; less than 2500 g is low birth weight; less than 1500 g is very low ; and less than 1000 g is extremely low birth weight.

What is the mortality rates by gestational age and birth weight ? Look at the following table:

Table 2 : Mortality rates by
gestational age and birth weight.
Gestational Mortality Birth
age [weeks]..rate [%] weight [g]
………………. 13……….1000-1250
Source: F, .John Bourgeois et al. OBSTETRICS and GYNECOLOGY RECALL. Baltimore, 2008, p 136

What are preventive measures for preterm labor?
Home uterine monitoring for women with a history of preterm labor. Preventive tocolytic agents for women at high risk for preterm labor.
Reduced activity and bed rest.
What are tocolytic drugs?
Agents that decrease uterine contractions by a variety of mechanisms; used to stop the progression of labor when continued uterine contractions or labor could have negative consequences.

What are the treatment of preterm labor?
Hydration and bed rest. Transfer of patient to a high risk facility.
Tocolytic therapy: Ritodrine or Terbutaline is commonly used for tocolysis drugs.
Ritodrine, Terbutaline, and similar drugs have been used to suppress premature labor.
The goal is to defer labor long enough to ensure adequate maturation of fetus. These drugs may delay labor for several days. This may afford time to administer corticosteroid drugs, which decrease the incidence neonatal respiratory distress syndrome.
Terbutaline [generic, Brethine] 2.5 and 5 mg tabled per oral 2-3 times daily, or subcutaneous injection one mg/ml.

The writer experience for treatment of preterm labor are antispasmodic drugs:
Hyoscyne-N-buthylbromide 10 mg /tablet 3 times daily, injection S.C. 20 mg/ ml, or Scopolamine 0.4 mg 3 times daily, combined with papaverine 40 mg/tablet 3 times daily, or injection I.M. 40 mg/ ml.
If the patients come with the preterm signs and symptoms, administer injection of both those antispasmodic drugs and then following by per oral intake.
If there is the sign of bleeding, administer vitamin K 5 mg per oral 3 times daily, vitamin C 1000 mg/tablet per oral once daily and Adona AC-17 [carbazochrome sodium sulfonate] 10 mg/tablet 3 times daily.

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