December 14, 2009

Case: Premature labour with PV Bleeding


a) 4 drugs in management of premature labour

b) Drugs for candidiasis

c) Function, complication and monitoring of the drugs

d) Doses of drugs

Definition of preterm

1) Onset of labour after the gestation of viability i.e 24 weeks and before 37 completed weeks of pregnancy.
2) The onset labour may be determined by documented uterine contractions and rupture membranes or documented cervical change with an estimated length of less than 1 cm and/or cervical dilatation of more than 2 cm.


a) Threatened (uterine contraction without cervical changes)

b) Actual/establish (uterine contraction+ cervical changes)

Additional: occurs in around 7% of all pregnancies and is a major cause of infant mortality and morbidity. [Scottish guidelines]

Survival rate: 23 w 0-8% 24w 15-20% 25w 50-60% 26-28w 85% 29w 90%

Drugs in management of premature labour

1) Corticosteroid therapy

- Betamethasone, 12mg, IM, 24 hours apart.

- In USM, Dexamethasone, 12 MG, IM, 12 hours apart.

- Function is to increase lung maturity. Usage of corticosteroid below 24w is no beneficial since pneumocyte not develop yet. Also not recommended >34W.

- Possible long-term effects on cognitive or neurological development, impaired glucose tolerance, osteoporosis and depression of fetal/maternal adrenals

2) Tocolytic


- calcium channel blocker: 10 mg q 6 h; se: nausea and flushing

B2 agonist

- ritodrine/ terbutaline

- dec. uterine stimulation; may cause DKA in hyperglycemia, pulm edema, n/v, palpitations (avoid with h/o cardiac disease or if vaginal bleeding) 0.25 mg sq q 20-30 min x 3 then 5 mg q 4 po

3) Antibiotic therapy

- For women at risk of preterm delivery because of PPROM, prophylactic antibiotics delay delivery and reduce maternal and neonatal infective morbidity.

- Not recommended in risk of preterm but with intact membranes

- Erythromycin 500mg qds plus co-amoxyclav (Augmentin) 375mg tds for 7 days OR clindamycin 150mg qds for 7 days.

Drug for candidiasis in pregnancy

Imidazoles are best but pregnant women may need longer (7 not 4 day) courses. Thrush is a common vaginal infection in pregnancy causing itching and soreness. There is no evidence that this yeast infection harms the baby. Antifungal creams are effective. Imidazoles (such as clotrimazole) are more effective than older treatments such as nystatin and hydrargaphen. Longer courses (7 days) cured more than 90% of women whereas standard (4 day) courses only cured about half the cases. [Cochrane Database of Systematic Reviews, Issue 4, 2009]

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