Prematur Labour with Bleeding

Questions
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 iabilit! i"e #4 wee$s and before %& completed
wee$s of pregnanc!" #) 'he onset labour ma! be determined b! documented uterine
contractions and rupture membranes or documented cerical change with an estimated
length of less than 1 cm and(or cerical dilatation of more than # cm"
'!pes
a) 'hreatened )uterine contraction without cerical changes)
b) *ctual(establish )uterine contraction+ cerical changes)
*dditional, occurs in around &- of all pregnancies and is a ma.or cause of infant
mortalit! and morbidit!" /0cottish guidelines1
0urial rate, #% w 234- #4w 153#2- #5w 52362- #63#4w 45- #7w 72-
Drugs in management of premature labour
1) 8orticosteroid therap!
3 Betamethasone, 1#mg, 9:, #4 hours apart"
3 9n ;0:, De<amethasone, 1# :=, 9:, 1# hours apart"
3 Function is to increase lung maturit!" ;sage of corticosteroid below #4w is no
beneficial since pneumoc!te not deelop !et" *lso not recommended >%4?"
3 Possible long3term effects on cognitie or neurological deelopment, impaired
glucose tolerance, osteoporosis and depression of fetal(maternal adrenals

#) 'ocol!tic
@ifedipine
3 calcium channel bloc$er, 12 mg A 6 hB se, nausea and flushing
B# agonist
3 ritodrine( terbutaline
3 dec" uterine stimulationB ma! cause DC* in h!pergl!cemia, pulm edema, n(,
palpitations )aoid with h(o cardiac disease or if aginal bleeding) 2"#5 mg sA A
#23%2 min < % then 5 mg A 4 po

%) *ntibiotic therap!
3 For women at ris$ of preterm delier! because of PPDO:, proph!lactic antibiotics
dela! delier! and reduce maternal and neonatal infectie morbidit!"
3 @ot recommended in ris$ of preterm but with intact membranes
3 Er!throm!cin 522mg Ads plus co3amo<!cla )*ugmentin) %&5mg tds for & da!s OD
clindam!cin 152mg Ads for & da!s"
Drug for candidiasis in pregnanc!
9midaFoles are best but pregnant women ma! need longer )& not 4 da!) courses" 'hrush is
a common aginal infection in pregnanc! causing itching and soreness" 'here is no
eidence that this !east infection harms the bab!" *ntifungal creams are effectie"
9midaFoles )such as clotrimaFole) are more effectie than older treatments such as
n!statin and h!drargaphen" Longer courses )& da!s) cured more than 72- of women
whereas standard )4 da!) courses onl! cured about half the cases" /8ochrane Database of
0!stematic Deiews, 9ssue 4, #227