Managing Complications in Pregnancy and Childbirth: - IAWG

S-124 Abdominal pain in later pregnancy and after childbirthPRETERM LABOURPreterm delivery is associated with higher perinatal morbidity andmortality. Management of preterm labour consists of tocolysis (tryingto stop uterine contractions) or allowing labour to progress. Maternalproblems are chiefly related to interventions carried out to stopcontractions (see below).Make every effort to confirm the gestational age of the fetus.TOCOLYSISThis intervention aims to delay delivery until the effect ofcorticosteroids has been achieved (see below).• Attempt tocolysis if:- gestation is less than 37 weeks;- the cervix is less than 3 cm dilated;- there is no amnionitis, pre-eclampsia or active bleeding;- there is no fetal distress.• Confirm the diagnosis of preterm labour by documenting cervicaleffacement or dilatation over 2 hours.• If less than 37 weeks gestation, give corticosteroids to the motherto improve fetal lung maturity and chances of neonatal survival:- betamethasone 12 mg IM, two doses 12 hours apart;- OR dexamethasone 6 mg IM, four doses 6 hours apart.Note: Do not use corticosteroids in the presence of frank infection.• Give a tocolytic drug (Table S-17) and monitor maternal and fetalcondition (pulse, blood pressure, signs of respiratory distress,uterine contractions, loss of amniotic fluid or blood, fetal heart rate,fluid balance, blood glucose, etc.).Note: Do not give tocolytic drugs for more than 48 hours.