The obstetric management of preterm labour

Preterm delivery remains the major cause of perinatal morbidity and mortality. It usually results from preterm labour, which may, in itself, have many causes.A detailed initial assessment (preferably using a standard protocol) should be undertaken in an attempt to diagnose any underlying pathology and to predict the likelihood of delivery. An appropriate plan of management can then be made, in conjunction with a senior experienced obstetrician and with the patient's informed agreement.Options are expediting delivery, delaying delivery or observation, the last two being combined with fetal therapy. Drug therapy can delay delivery in the short-term and should also be considered with ruptured membranes. Time gained allows for fetal therapy to have benefit and if necessary in utero transfer to a unit better equipped for neonatal intensive care. Fetal therapy with maternal administration of corticosteroids should be practised in almost all cases where there is a risk of respiratory distress syndrome. Thyrotropin releasing hormone therapy may soon be introduced.There are no data to support a number of practices such as prophylactic antibiotics with ruptured membranes and routine operative delivery even for the breech presentation.Most of the credit for improvements in neonatal morbidity and mortality must rest with the paediatricians. However, the obstetrician and midwife have a major role in presenting a neonate — who is not bruised or asphyxiated, is ‘matured’ and at an advanced gestation as possible — to paediatricians prepared to provide appropriate care.