Preterm Labor: Evidence Based View
Preterm Labor: Evidence Based View
Preterm Labor: Evidence Based View
A.KURDI SYAMSURI
Evidence Based Sources:
PubMed
Cochrean library
RCOG Guidelines
ACOG Issues Guidelines
National Guideline Clearinghouse
MOH Sing. Guideline
Definition
Preterm labor is the presence of
contractions of sufficient strength
and frequency to effect
progressive effacement and
dilation of the cervix between 20
and 37 weeks' gestation
WHO
Preterm Labor
Incidence : 6- 10%
• Spontaneous : 40-50%
• PROM : 25-40%
0.5
Probability of Preterm Delivery
0.4
0.3
0.2
0.1
0.0
0 20 40 60 80
Amnion
Chorion
Fetal
Fibronectin
Decidua
Figure 11. Fetal Fibronectin vs Gestational
Age
4500
Fetal Fibronectin (ng/mL)
Nifedipine = Epilate
Atosiban= Tractocile
Choice Of Tocolytic Drug
If a tocolytic drug is used, ritodrine no
longer seems the best choice.
Atosiban or nifedipine appear
preferable as they have fewer adverse
effects and seem to have comparable
effectiveness.
50 mg Loading dose
Then 25-50mg /6hs
Newton eMedicine 2002
Atosiban: Tractocil
Atosiban, a synthetic
peptide, is a competitive
antagonist of oxytocin at
uterine oxytocin
receptors.
Atosiban: Tractocil
Atosiban - compared with beta-agonists-
has:
Little difference in the effect of these agents on
delayed delivery
Fewer maternal adverse effects than beta-agonists,
such as chest pain, palpitations , tachycardia ,
hypotension , dyspnoea ,vomiting , and headache.