Preterm labor

• Devyatova E.A.

Abstract

Objective. Preterm labor (PL) is actual problem for world health services. The trend of PL rate is increasing. 80 % of newborns’ morbidity and mortality is associated with PL. Preterm rupture of membranes (PROM) in prematurity is a widely spread complication of PL (1 per 3 PL). PROM is also closely connected with high newborns’ morbidity and mortality, and maternal morbidity. The research of predictors and prophylaxis of PL remains a sharp question, standing one line with effective therapy challenges and evaluation of delivery strategies to decrease poor offspring of prematurity.

Aims. To evaluate risk factors for PL; role of prophylactic nifedipine administration in cases of PL risk; advisability of betamimetics in PROM cases to prevent PL; comparison of effectiveness cyclo-oxygenase inhibitors, Саlcium channel blockers, antibiotics, corticosteroids and their combinations in high-risk cases of PL; methods of delivery for prematurity; possibility of prostaglandins administration for cervix ripening and labor induction for PROM.

Materials and methods. Limited to the English literature PubMed, EMBASE, MedLine and the Cochrane Library were searched for randomised trials in 2013–2014, devoted to PL and PROM problems: risk management, medical approach, care strategies.

Results. Previous PL and bacterial vaginosis in this pregnancy are strong predictors of PL. Risk factors for PROM are smoking, low social status, genital infections, vaginal bleeding. Multiparous at high risk of PL having shortening cervix less than 25 mm are recommended to administrate nifedipine. Threatening PL and PROM is indication for tocolitics at gestational age less than 34 weeks.

They do not demonstrate negative impact on perinatal mortality, however risk of chorioamnionitis increases. Recent data show premature neonates’ mortality decline for Cesarean delivery in 37 % cases in comparison to vaginal delivery in breech presentation. PROM labor induction for multiparous with unfavorable cervix may include vaginal misoprostol which is not associated with significant maternal and fetal complications risks gain. Therefore extra scientific research is desired.

Keywords:preterm labor, risk, bacterial vaginosis, rupture of membranes, tocolytics, delivery, Cesarean section, misoprostol

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