Management of Threatened Preterm Birth (PTB)

1. Management of Threatened Preterm Birth (PTB)

2. Learning Objectives Attheendofsession, thelearnerswill beable to: • Describe the identification of threatened preterm birth (PTB) • Explain the management of threatened PTB • Explain the needforantenatal corticosteroids(ANCS), typeofcorticosteroid,dose and when togive

3. Preterm Birth is a Leading Cause of Neonatal Deaths in India Mortality and morbidity due to prematurity can be prevented by providing PTB care & interventions: • To all pregnant women- primary prevention & reduction of risk of PTB e.g. smoking cessation program • To pregnant women with known risk factors e.g. on progestinagents, cervical cerclage • To pregnant women in which PTB is inevitable - most beneficial • Essential & additional care to preterm newborns to prevent or treat potential complications Causes of neonatal deaths

4. Criteria for Management of Threatened PTB • Accurate gestational age assessment • Accurate diagnosis of conditions leading to PTB • Rapid identification and treatment of maternal infection • Adequate preterm newborn care, including: • Resuscitation • Thermal care • Feeding support • Infection treatment • Safe oxygen use

5. Correct estimation of GA for identification of PTB Source: Helping Mothers & Babies Survive If < 37 weeks, and birth expected in next 7 days: Plan for PTB care

6. Conditions leading to PTB • Antepartum Haemorrhage (APH) • Preterm Pre-labour Rupture of Membranes (PPROM) • Severe Pre-eclampsia/Eclampsia (PE/E) • Infection of genital tract • Conditions leading to over distension of uterus If < 37 weeks, and birth expected in next 7 days: Plan for PTB care

7. Plan for PTB care depending on GA and condition Source: Helping Mothers & Babies Survive

8. Antenatal Corticosteroids • Estimation of correct gestational age is a critical function before administering ANCS • For preterm labour between 24-34 weeks gestation give antenatal corticosteroids to mother for baby’s lung maturity • Antenatal corticosteroid therapy has maximal effect if the foetus is delivered 24 hours after the last dose and up to 7 days thereafter • Partial effect is evident within a few hours before birth • Drugs and dosage

9. Which corticosteroid should be given • Dexamethasone is a more appropriate option and recommended over Betamethasone because • Easily available (included in WHO essential drug list) • Inexpensive • Heat stable (no need to refrigerate) • Oral Preparations of steroids are not to be used • ANCS have a role even if surfactant replacement is available • Repeated courses/more frequent doses are not useful. Multiple courses in fact could have harmful neuro-developmental effects in the baby

10. When to give Antenatal Corticosteroid? • Indications • 1. True preterm labour (between 24-34 weeks of gestation) • 2. Conditions that lead to imminent delivery (between 24-34 weeks of gestation) • Antepartum haemorrhage • Preterm pre-labour rupture of membrane • Severe pre-eclampsia/Eclampsia • Contraindications • Frank Chorioamnionitis (absolute contraindication) • Signs and symptoms of chorioamnionitis • H/O fever, lower abdominal pain • Foul smelling vaginal discharge • Tender uterus • Maternal and foetal tachycardia

11. Other medications for PTB management Source: Helping Mothers & Babies Survive

12. KeyMessages • Preterm birth isa leadingcauseof neonatal deaths • Mortality due to PTB canbepreventedby giving PTB care & interventions • Important maternal interventions for threatened PTB are: use of ANCS, MgSO4, Antibiotics & Tocolysisto delay labour • Accurate estimation of GA is crucial for deciding intervention • Important newborn interventions for PTB are: Newborn Resuscitation, Thermal Care, Feeding Support, Infection Treatment & Safe Oxygen Use