O60/O42.2/O60.0
DESCRIPTION
Preterm: <37 weeks gestation.
Most problems occur at <34 weeks’ gestation.
Confirm ruptured membranes by sterile vaginal speculum.
Preterm labour confirmed by regular uterine contractions with progressive cervical changes.
GENERAL MEASURES
Assess fetal wellbeing.
Estimate fetal weight.
Deliver if chorio-amnionitis suspected.
MEDICINE TREATMENT
If gestation <34 weeks:
Pre-hydrate before administration of nifedipine:
- Sodium chloride 0.9%, IV, 200 mL.
AND
- Nifedipine, oral, 20 mg.
- If contractions persist, follow with 10 mg after 30 minutes then 10 mg 4 hourly for up to 48 hours.
If gestation <32 weeks and where nifedipine contra-indicated:
- Indomethacin, oral, 50 mg immediately then 25 mg 4 hourly for up to 48 hours.
Note: Indomethacin may cause oligohydramnios, and its use is associated with a risk of premature closure of the ductus arteriosus. Use only if there is intolerance to nifedipine.
LoEI [23]
To improve fetal lung maturity at 26–34 weeks: (Z29.2)
- Betamethasone, IM, 12 mg, 2 doses 12–24hours apart.
If betamethasone is not available:
- Dexamethasone, IM, 8 mg, 3 doses 8 hours apart.
Note: Corticosteroids are maximally effective from 24 hours after administration of the first dose. Therefore give as soon as possible following diagnosis of PTL or PPROM.
Antibiotic therapy (Z29.2)
Indicated routinely for PPROM only:
- Amoxicillin, oral, 500 mg 8 hourly for 5 days.
AND
- Metronidazole, oral, 400 mg 8 hourly for 5 days.
Severe penicillin allergy: (Z88.0)
- Azithromycin, oral, 500 mg daily for 3-5 days
AND
- Metronidazole, oral, 400 mg 8 hourly for 5 days.
Prepare for appropriate care of preterm infant.
REFERRAL
- Fetus that may require neonatal intensive care, e.g. estimated weight <1.5 kg or gestation <32 weeks.
- Fetus requiring specialised treatment after birth, e.g. surgery.
- Severely ill mother.