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Why the hours gained in pre-term labor are crucial

Lung immaturity is one of the most feared problems in prematurity. After about 24 weeks of gestation, an administration of steroids - usually in the form of two injections significantly improves the functional capacity of the baby's lungs, thus improving its chances of survival and chances of survival without handicap. The injections are administered 12 or 24 hours apart.

 

Where suppressing labor is not a good idea

However preterm the labor might be, no attempt to suppress it will be made in the presence of:

• Placental abruption
• Severe vaginal bleeding
• Severe pre-eclampsia or eclampsia
• Infection affecting the pregnancy itself (chorioamnionitis)
• Fetal distress
• Fetal abnormalities incompatible with life.

 

As has been mentioned before, if the gestation is over 34 weeks, in most instances labor won't be suppressed. However, there is room for flexibility here and assessment may lead to a decision to try to prolong labor if it is perceived that the fetus is likely to benefit from this.

 

Labor suppressants (tocolytics)

There are various types of drugs used to suppress labor. The most popular type by far are the group known in medical parlance as ‘beta-agonists’ (ß-agonists). The side-effects of these include palpitations, lung congestion and occasionally chest pains, rising blood sugar levels (hence great care is needed if the patient is diabetic), and lowering blood pressure. Of these, the most common and most vexing, as far as the patient is concerned, is palpitations. The most serious (and fortunately rare) one is lung congestion (edema).

Atosiban is another popular labor suppressant. It antagonizes the action of oxytocin which is the chemical responsible for uterine contractions.

Nifedipine, which belongs to a class of drugs known as calcium-channel blockers, traditionally used for treating raised blood pressure (hypertension) and cardiac conditions is also sometimes employed to suppress labor.    

None of the named drugs has a decisive edge over the rest in terms of effectiveness.

 

Preventing recurrence of preterm delivery

Studies have shown that the use of weekly progesterone (Progestin) injections or daily suppositories could help reduce recurrence of preterm delivery (for those identified to be at risk) by up to a third. 17-alpha hydroxyprogesterone caproate, also called ‘17P’ is employed for this. It is a natural progestin and safe to use in pregnancy.

 

Delivery plan in pre-term labor: Next Page

Tractocile (Atosiban) is one of the drugs used to delay delivery in  preterm labor