Chapter 13 Preterm labour and preterm premature rupture of membranes
PRETERM LABOUR
The World Health Organization (1992) defined preterm birth as delivery before 37 weeks of pregnancy. On the basis of this definition between 6% and 10% of births are preterm (5.6% in Oceania, 5.8% in Europe, 11–12% in America) but around 50% deliveries are more than 35 weeks’ gestation with near 100% survival expected of babies born after 32 weeks of pregnancy. Intact survival exceeds 50% after 27 weeks and improves as gestation increases towards 32 weeks. In this group (27–32 weeks’ fetus) every effort must be made to enhance survival and optimise quality of life.
PRETERM LABOUR: GENERAL STATEMENTS
When preterm labour presents the following considerations are important:
PRETERM LABOUR AT 23–26 COMPLETED WEEKS
Preterm labour and delivery at these extremely early gestations presents both ethical and clinical challenges. The following current evidence will help counselling:
CERVICAL CERCLAGE
Emergency cerclage has been performed for gestations as late as 26 completed weeks with intact membranes and cervical dilatation between 3 cm and 10 cm. The reported rate of perinatal survival is 45–63%. When compared with conservative management with bed rest the incidence of infection, need for caesarean section and perinatal mortality appeared similar. A successful outcome is more likely before 20 weeks’ gestation for cervical dilatations of less than 4 cm, when C-reactive protein is less than 4 mg/dl and the white cell count is below 14 000. Cervical cerclage requires:

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