Active management of preterm labour and preterm prelabour rupture of membranes

ABSTRACT

Hundred cases of preterm labour [before 36 weeks] with cervix 4 cm or less dilated and preterm prelabour rupture of membranes [excluding cases of uterine overdistension, maternal medical disorders and fetal congenital abnormalities] were treated with bed rest and sedation. Labour set in within 2-6 days with high fetal morbidity and mortality. Another fifty similar patients were given in addition to rest in hospital for 48 hours, 1000 ml of 5% dextrose in six hours, intravenous antibiotics [after sending off cultures from the vagina per speculum], cotricosteroids and a single dose of analgesia/sedation injection. In 85% painful contractions ceased and membranes stopped leaking until near term. In 10% painful contractions ceased, but leakage continued for 2-7 weeks, and the gain in intrauterine life led to 100% neonatal survival with short hospital stay in the neonates born after 31 weeks. Only 5% failed to respond to treatment and after delivery these premature neonates developed pneumonia and speticaemia from the same organisms that were colonizing their maternal genital tract and had entered the fetus via the infected amniotic fluid. It is recommended that all patients in preterm labour or preterm prelabour rupture of membranes [excluding overdistension] be given besides bed rest and sedation, corticosteroids and antibiotics intravenously for 48 hours and then orally for eight more days. Tocolytics are not recommended. This regime saves babies