preterm

• Estimates of preterm birth rates range from 5% in developed countries to 25% in developing countries
• Bhutan has a preterm prevalence rate of 6.4% (64 per 1000 live births)
• Premature birth is a serious public health concern where one in 10 babies are born premature, accounting for about 1,300 preterm births in a year
• Factors that give us the opportunity to take preventive measures and provide quality care to preterm babies

  • Anemia
  • Lack of family planning
  • Cervical insufficiency
  • Low socio-economic factors
• About 85 percent of preterm babies are born at 32 to 37 weeks
• Breastfeeding practice among Bhutanese mothers has reached 99.3 percent of mothers with children less than two years ever breastfed, but the 2015 National Nutrition Survey showed exclusive breastfeeding at only 51.4 percent
• The threshold for viability depends on the facilities and advancement of NICU unit and personnel
• International "prematured day" is celebrated

  17th November
• Fetal lung


  • Significantly mature by 34 weeks of gestation but definitely completed by term
  • Lung maturity happens due to surfactant which starts getting secreted from 20 weeks and can be seen in amniotic fluid from 28 weeks of gestation
• Causes of preterm labor

  • Spontaneous unexplained preterm labor with intact membranes (maternal/fetal stress, poly, infection, bleeding, cervical incompetence, abnormal uterus)
  • Preterm pre-rupture of membranes
  • Iatrogenic (e.g. Induce labor at early term related to some other complications)
  • Multiple pregnancy
• Risk factors for preterm labor

  • Previous preterm
  • Advanced maternal age and extreme maternal weight
  • Interpregnancy interval (frequent birth)
  • Bleeding in early pregnancy
  • Chronic stress
  • Smoking
  • Infection
  • Huge fibroids
• Signs and symptoms of preterm labor

  • Regular or frequent contractions
  • Lower back pain
  • Abdominal cramping
  • Vaginal bleeding or spotting
  • Changes in vaginal discharge
  • Pelvic pressure
  • Sensation that the baby is "balling up" inside
  • Abdominal tightening
  • Increase in pelvic pressure or the feeling that the baby is pushing down
• Conservative or arrest management of preterm labor


  1. Confirmation of gestation age and rule out maternal and fetal compromises

  2. Identify the high risk woman and encourage adequate rest, diet modification, cervical cerclage

  3. Use tocolytic agent if less than 33 weeks (nifedipine, indomethacine, salbutamol or ritodrine)

  4. Give corticosteroid (24-34 weeks) to mature fetal lung

  5. Give prophylactic antibiotic if membranes is ruptured

  6. Give MgSO4 preterm before 32 weeks to prevent cerebral palsy in infant and child
• Actual management of preterm labor

  1. Allow to progress if gestation is more than 34 with active labor, abruption of placenta, fetal compromised, death fetus, chorioamniotis, pre-eclampsia/ eclampsia

  2. Best rest at left lateral with O2 supply

  3. Give sedative or epidural analgesia

  4. Close monitoring of labor progress and fetal monitoring

  5. Perform cesarean section if any complications occur

  6. Prefer episiotomy to prevent fetal decompression and compression

  7. Immediate cord clamp to prevent hypervolumia and hyperbilirubinemia

  8. Suction very gentle or stomach content must be suck out

  9. Administer oxygen and maintain temperature closely as preterm may go into hypothermia very easily

  10. Give Vitamin K to prevent hemorrhage

  11. Strictly prohibited baby bath

  12. Monitor Fetal weight monitoring and feeding (3hrly) with NG feeding under radiant warmer if necessary

  13. KMC is very effective