Premature contraction

Case: 33 years old, G3P2 present at 24W+5D POA with premature contraction. No history of UTI, Vaginal discharge, trauma.

Question

A) How to differentiate premature contraction and true labour contraction

B) Management of this patient

C) How to discharge this patient

Premature contraction

Uterine contraction after the gestation of viability. i.e 24W and before 37 completed weeks of pregnancy. It could progress to premature labour.

It is called threatened pre term labour if contraction is not associated with cervical dilatation.

If it is associated with cervical dilatation, hence it is termed as Establish Pre term labour.

Characteristic of a true labour

1) At term

2) Come at regular interval i.e once in one hour and finally can goes to once in five minutes near labour.

3) The timing of each contraction is last about 30-70 seconds

4) The intensity of pain increase by time. Pain is at the back due to referred pain of cervix.

5) The pain does not relief by walking or changing in posture.

6) Presence of show and liquor.

Management of this patient

1) Obtain full history and perform relevent physical examination.

2) Admit patient to premature room in labour room.

3) Inform the case to MO in charged

4) Re assure the patient

5) Give IM Dexamethasone 12mg bds, 12 hours apart.

6) Keep patient nill by mounth and anticipate for caesarian section.

7) Hydrate patient adequately with 2 pints NS and 3 pints D5%

8) Take blood for investigation including FBC, GSH.

9) Urine dipstick (nitrogen, albumin= indicate UTI) and Urine FEME.

10) Allocate possible causes of premature contraction.

11) Monitor 4 hourly BP, 20 minutes CTG

12) Inform Pediatrician regarding patient's condition and keep in view to book for ventilator.

13) Monitor the labour progression by labour progression chart.

14) Ultrasound examination for fetal well being.

15) Administer tocolytic for example Nifedipine 5mg (some specialist give 10 mg)

16) Observe patient for one day. if contraction subside, discharge patient to ante natal wards for further observation.

17) If contraction subsides for two consecutive days in ante natal wards, then patient can be discharged

Discharging the patient

1) After no contraction within 2 days in ante natal wards

2) Ensure that patient already took dexamethasone.

3) CTG reactive.

4) Follow up at ante natal clinic within 2 weeks.

5) Fetal Kick Chart (some protocol say it is not indicated)