HISTORY
-
Age of the patient at the time of conception
-
Education status and occupation of the patient and
socioeconomic status
-
Period of gestation
PRESENTING COMPLAINTS
-
H/o pain abdomen, nature and severity of pain, duraiotn
-
Whether pain associated with hardening of uterus
-
H/o any urinary frequency or urgency, burning
-
H/o fever
-
H/o thyroid disorder/PIH/heart disease
TREATMENT HISTORY
1st
trimester
-
exact last menstrual period and UPT, USG confirmation for
exact dating
-
H/o fever/rash/drug exposure
2nd
trimester
-
H/o of quickening
-
H/o of leading p/v discharge p/v, bleeding p/v or pain
abdomen
-
H/o early onset PIH
MENSTRUAL HISTORY
-
Menarch
-
LMP
-
Regularity of cycles
OBSTETRICS HISTORY
-
Duration of marriage
-
H/o any treatement taken for infertility
-
H/o previous preterm birth
-
H/o any D & C done in past
-
H/o any surgery done on the cervix or any encirclage
procedure done in the past
-
Sequence of events of pregnancy loss – leaking P/v, Bleeding
P/v, abdominal pain
-
Any significant postpartum events ( H/o puerperal
sepsis/fever or foul smelling discharge)
Past history of
DM/jaundice, asthma, thyroid disease any surgery done on cervix
Personal history
-
Addiction to drugs, alcohol, cigarette smoking
-
Socioeconomic status
-
Nutritional adequacy
Family History
-
H/o DES exposure in the mother of the patient
-
H/o DM/HT/thyroid disorder
-
H/o recurrent preterm births in family
-
H/o of GCA in the baby in the family
Examination
-
Height
-
Weight
-
BMI
-
Pulse
o
BP
o
Thyroid examination
-
Breast (pregnancy change of breast)
Per Abdomen
-
Uterine fundal height, whether corresponding to gestational
age or not
-
Any uterine activity ( whether any contractions present or
not )
-
Presentation of the fetus
-
Estimated baby weight
-
Liquor volume
-
Fetal heart rate auscultation
Per speculum
-
Any discharge P/V
-
Leaking and bleeding P/V
-
Cervical os dilation/funneling of the cervix
Per vagnum
-
Cervical length, dilatation of os, funneling of the cervix
Investigations
-
BG, RH typing
-
Complete blood count (TLC, DLC)
-
Sugar – fasting and post prandial
-
Urine – routine and microscopy + culture
-
HVS-C/S or cervical smear – culture and sensitivity
USG
-
Fetal maturity, viability and fetal growth biometric
parameters
-
To rule out GCA
-
Liquor volume
-
Placental localization and grading
-
Uterine congenital anomaly
-
Cervical parameters- length, dilatation or funneling of the
cervix
Management of preterm
labour
-
Management of patient with warning symptom of preterm labour
-
Management of patients in established preterm labour
Management of
patient with warning symptoms
1)
Bed rest
2)
Reassurance
3)
Treatment of any risk factors for preterm labour – treatment
of vaginal infection, urinary tract infection, fever or medical disorder like
PIH, renal disease
4)
Sedation may be considered
5)
Glucorticoids may be considered
6)
Role of tocolysis in inhibiting preterm labour – only when
uterine contraction are present and associated cervical dilation is there,
under 2 conditions.
a.
For the effect of – gluocorticoids can set in 24 hours,
tocolysis can be given.
b.
For the transfer to a tertiary care unit, where good nursery
care facilities are available.
Identification of
patient in whom the preterm labour need not be inhibited
-
Advanced preterm labour
-
Choriomnionitis
-
Fetal congeniatl anomaly
-
Severe fetal growth restriction
-
Disease detrimental to meternal health
o
Uncontrolled DM
o
Severe preeclampsia, eclampsia.
Management of
established preterm labour
-
Glucorticoids (inj. Betamethasone 12mg I/M repeat 12mg after
24 hrs.)
-
Tocolysis may be considered if no contraindication to its
use are present and till the time glucorticoids action sets in
o
Beta-adrenrgic agents
o
Isoxurpine
o
Ritodrine
o
Terbutaline
o
Calcium channel blockers
o
Magnesium sulpate
o
Indomethacin
-
Nursery and pediatrician to be informed
-
Intensive labour monitoring and aseptic precautions at the
time of delivery.
No comments:
Post a Comment