Premature labour

Prematurity is by far the commonest cause of neonatal morbidity and mortality. The management of premature labour is empirical because little is understood about the mechanism of labour. Effective uterine relaxant drugs have an important, albeit minor role. Phototherapy has reduced the complications of neonatal hyperbilirubinemia, and the beneficial effect of antepartum corticosteroid therapy in minimizing the risk of respiratory distress syndrome is now convincing. Prophylactic antibiotic therapy in premature rupture of the membranes does not alter perinatal mortality, although postpartum maternal morbidity is reduced. The introduction of neonatal intensive care units has improved the survival rate of premature infants. Sound clinical judgement remains the mainstay in the management of premature labour.     

Induction of labour

The only justification for adding to the extensive literature on induction of labour is to bring together relatively inaccessible but relevant data for the general reader. Some of these data refer to current practice, and some to patients' experiences. The conflicting value systems of some doctors and some patients are also discussed. The writer, a self-confessed armchair critic, makes some suggestions about ways of reducing disagreement about elective induction of labour.     

Premature labour.

Intravenously administered salbutamol inhibited premature labour for at least 48 hours in 49 of 76 patients (64%), but was more effective (89%) when the cervical dilatation was less than 2 cm, and no apparent cause for the premature labour was evident. Even when premature labour complicated multiple pregnancy, hydramnios, or followed a small antepartum haemorrhage, suppression of labour could often be achieved for at least 48 hours, thus following the administration of betamethasone or the transfer of the patient to a hospital with intensive care facilities for both mother and child. Treatment with betamethasone, in addition to salbutamol, was associated with a less severe form of respiratory distress syndrome, and did not increase the risk of maternal or fetal infection, except in patients with cervical incompetence when 46.2% of such patients were infected.