Management of Threatened Preterm Birth (PTB) - PowerPoint Presentation

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Management of Threatened Preterm Birth (PTB)

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t the end of session, the learners will be able to: Describe the identification of threatened preterm birth (PTB)Explain the management of threatened PTBExplain the need for antenatal corticosteroids (ANCS), type of corticosteroid, dose and when to give

Learning

Objectives

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Preterm Birth is a Leading

Cause of Neonatal Deaths in IndiaCauses of neonatal deathsMortality 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 programTo pregnant women with known risk factors e.g. on progestin agents, cervical cerclageTo pregnant women in which PTB is inevitable - most beneficialEssential & additional care to preterm newborns to prevent or treat potential complications

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Accurate

gestational age assessmentAccurate diagnosis of conditions leading to PTBRapid identification and treatment of maternal infectionAdequate preterm newborn care, including:ResuscitationThermal careFeeding supportInfection treatmentSafe oxygen useCriteria for Management of Threatened PTB

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Correct estimation of GA for identification of PTB

If < 37 weeks, and birth expected in next 7 days: Plan for PTB careSource: Helping Mothers & Babies Survive

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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 uterusIf < 37 weeks, and birth expected in next 7 days: Plan for PTB care

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Plan for PTB care depending on GA and condition

Source: Helping Mothers & Babies Survive

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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 maturityAntenatal corticosteroid therapy has maximal effect if the foetus is delivered 24 hours after the last dose and up to 7 days thereafterPartial effect is evident within a few hours before birthAntenatal CorticosteroidsInjection Dexamethasone 6 mg intramuscularly, 12 hourly 4 doses ORInjection Betamethasone 12 mg intramuscularly, 24 hours apart 2 doseDrugs and dosage

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Which corticosteroid should be given

Dexamethasone is a more appropriate option and recommended over Betamethasone because Easily available (included in WHO essential drug list)InexpensiveHeat stable (no need to refrigerate) Oral Preparations of steroids are not to be usedANCS have a role even if surfactant replacement is availableRepeated courses/more frequent doses are not useful. Multiple courses in fact could have harmful neuro-developmental effects in the baby

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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 haemorrhagePreterm pre-labour rupture of membraneSevere pre-eclampsia/EclampsiaContraindicationsFrank Chorioamnionitis (absolute contraindication)Signs and symptoms of chorioamnionitis H/O fever, lower abdominal painFoul smelling vaginal dischargeTender uterusMaternal and foetal tachycardia

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Other medications for PTB management

Source: Helping Mothers & Babies Survive

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reterm birth is a leading cause of neonatal deaths Mortality due to PTB can be prevented by giving PTB care & interventionsImportant maternal interventions for threatened PTB are: use of ANCS, MgSO4, Antibiotics & Tocolysis to delay labourAccurate estimation of GA is crucial for deciding interventionImportant newborn interventions for PTB are: Newborn Resuscitation, Thermal Care, Feeding Support, Infection Treatment & Safe Oxygen Use Key Messages