Preterm labor (8th month Pregnancy)

When labor start before the 37th completed week, counting from the first day of the last menstrual period. The prevalence widely varies and ranges between 5-10%.The exact reason of premature onset is not know.
The following however, related with increased incidence of preterm labor:

---- Spontaneous abortion, previous history if induced or preterm delivery.
---- Recurrent urinary tract infection.
---- Smoking habit.
---- Low socio-economic and nutritional status.
---- Pregnancy complication such as pre-eclampsia, haemorrhage, premature rupture of the membranes.
---- Uterine anomalies such as malformation of uterus.
---- Medical and surgical illness such as fever ,acute appendicitis, diabetes, abdominal operation, hypertension, heart lesion, severe anaemia.
----  Genital tract infection.


In such case i.e. preterm labor minimize the risk of perinatal mortality and morbidity, to preserve maternal health. In such situation prevent premature onset of labor, if possible. Arrest premature onset of labor ,if possible. Give effective neonatal care.

  
As cause of preterm is known. After knowing all complication of pregnancy decision has to be taken whether to allow the pregnancy to continue or not. The risk of delivery of a low birth weight baby has to be weighed against the risk involved to the unborn and mother in continued pregnancy.

• After identifying risk factor by taking history, the defects are rectified suggest adequate rest, nutritional supplements, avoidance of smoking.
   
• In some case early engagement of the head should be viewed. In such condition the patients are to be put to bed rest .
   
• Be sure about gestational age before induction.
   
• Selective continuation of complicated pregnancy such as twins, pre-eclampsia.

To arrest preterm labor, delay delivery for at least 24hours for glucocorticoid therapy to the mother to enhance fetal lung maturation, if premature labor starts before34th week. In utero transfer of the patient to a unit more able to manage a preterm neonate.

Contraindications of preterm labor are :

A. Maternal: Diabetes, severe hypertension, cardiac disease, haemorrhage in pregnancy.

B. Fetal : Fetal distress, fetal death, congenital malformation, pregnancy before 34 weeks.

C. Others: Rupture of membranes, cervical dilatation more than 4cm.

• The patient is put to bed to prevent early rupture of the membranes.
   
• To ensure adequate fetal oxygenation by giving oxygen to the mother by mask.
   
• Strong sedative or acceleration of labor should be avoided.
   
• Labor should be watched by intensive clinical monitoring in the absence of continuing electronic monitoring.
   
• The birth should be gentle and slow to avoid rapid compression and decompression of the head.
   
• Tendency to delay is curtailed by low forceps.
   
• The cord is to be clamped immediately at birth.
   
• To place the baby in the intensive neonatal care unit .

Intrauterine fetal death means fetal death occurring during pregnancy before or after 28th week of gestation and during labor. There are many reason responsible for fetal deaths during pregnancy are related to number of maternal or fetal complication which are produce either chronic or acute placental insufficiency.