Problems and challenges in the management of preterm labour

Abstract

The main problem with preterm labour is our lack of progress in the successful management of this condition. We need to reassess our approach to this problem because preterm labour is not a disease, but an event, which may result from multiple independent pathways. This problem has also been affected significantly by medical advances such as infertility treatments and changes in neonatal survival at the limit of viability. The specific challenges that we face in managing preterm labour include: problems with definition; aetiology, including genetic and infection components; diagnostic problems, such as true versus false labour and role of cervical length and fetal fibronectin; and specific interventions according to the antepartum, intrapartum and postpartum challenges. In order to address the main issue, and make future progress in the management of preterm labour, we should consider the implementation of a 'Postpartum Preterm Labour Diagnostic Workup Protocol'. These data/workup results could be entered on web-based databases for each preterm labour 'event'. An international research team could analyse data relating to specific aetiological patterns and subgroup analyses, leading to the collaborative development of 'aetiology specific' management modalities. This approach requires a close collaboration between clinicians and researchers, in order to make significant progress in this difficult area, and ultimately improve perinatal outcomes.

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa

“…When providing care to preterm babies the individualised care was preferred, however, the structure of the unit, shortage of staff and equipments was a barrier. McNamara indicated that there are various challenges to the management of preterm labour which may require individualised approaches for different patients, using expert committees or guidelines as the backbone of the management plan [22]. In this study, it was difficult to achieve individualised care because of shortage of competent staff, limited equipments, and the required sizes of the equipments and overcrowded units.…”

“…Insufficient KMC rooms is common in most low income countries [26]. Preterm babies were found to be suffering from RDS which is a condition related to prematurity and accounts for 15% morbidity in infants born at 34 weeks and 3.2% in those born at 36 weeks [22]. While most premature babies were born just a few weeks early.…”

“…A need for constant training for midwives regarding care of preterm infants 1.6. Importance for a proper structure to house preterm infants which will lead to quality care provision Syndrome (RDS) related to prematurity accounts for 15% morbidity in infants born at 34 weeks and 3.2% in those born at 36 weeks [22]. The following citation made by participant number 1 from hospital A was in agreement:…”

Perinatal Risk Factors and Mode of Delivery Correlated to Survival and Psychomotor Disability in Extremely Low Birth Weight Infants

“…In the past 20 years, improvements in perinatal medicine (modern neonatal resuscitation techniques, wide utilization of corticosteroids and surfactants, antibiotic therapy and the increasing practice of transferring to tertiary maternity before birth) has significantly improved the survival rate of infants of extremely low birth weight (ELBW, between 24 and 27 completed weeks of gestation) [1][2][3] . Nevertheless, preterm birth and extreme prematurity represent a serious public health concern with major economic implications [4] , being the leading cause of neonatal mortality and morbidity [5][6][7] .…”

“…Nevertheless, preterm birth and extreme prematurity represent a serious public health concern with major economic implications [4] , being the leading cause of neonatal mortality and morbidity [5][6][7] . Moreover, the relevant risk of psychomotor handicap among ELBW infants causes a great deal of anxiety for parents and physicians in choosing between active management or a waitand-see attitude [2,8] . It is important to identify all those perinatal factors that might affect the long-term prognosis of ELBW infants, especially the most controversial ones as tocolytic therapy and mode of delivery [9,10] .…”