Caesarean Section (C/S) Preterm Labour: BY MSC Zahraa Abdul Ghani M.A

Caesarean section (C/S)
Preterm labour
BY
MSC ZAHRAA ABDUL GHANI M.A.
Cesarean section is a term used to describe the delivery of a
vaiable fetus through an incision in the abdominal wall and the
uterus.
The majority of cesarean sections are performed for fetal
indications, a few are soly for maternal reasons, and some benefit
both fetus and mother.
Common indications for cesarean delivery
1. Precious (high risk) Fetus
2. Prolonged labour or a failure to progress (dystocia)
3. Apparent fetal distress
4. Aapparent maternal distress
5. Complications (pre-eclampsia, active herpes)
6. Catastrophes such as cord prolapse or uterine rupture
7. Mmultiple births
8. Abnormal presentation (breech or transverse positions)
9. Failed induction of labour
10. Placental problems (placenta praevia, placental abruption or
placenta accreta)
11. Umbilical cord abnormalities (vasa previa, multi-lobate
including bi-lobate and succenturiate-lobed placentas,
velamentous insertion)
12. Contracted pelvis
13. Sexually transmitted infections such as genital herpes
(which can be passed on to the baby if the baby is born
vaginally, but can usually be treated in with medication and do
not require a c-section)
14. Previous caesarean section prior problems with the healing
of the
15. Perineum (from previous childbirth or Crohn's Disease).
Complications of C-section
• Most of the serious complications associated with cesarean section are not
due to the operation itself. Instead, the complications arise from the indication
for the cesarean section.
• For example, a woman whose placenta separates prematurely (placental
abruption) may require an emergency cesarean section, Under these
circumstances, complications arise primarily from the placental abruption
itself. Fortunately, serious complications are rare.
• However, the following minor complications can occur in women having

cesarean sections
1. Infection
2. Bleeding
3. Atony
4. Lacerations
5. Placenta Accreta
Blood Clots .6
Preterm Labor
Risk factors for preterm labor
1. Twin pregnancy
2. Uterine abnormalities
3. Vaginal fibronectin
4. Age and race: increased age will increase the
incidence of preterm labor. Black people have a short
gestational period and their infants are of lower weight
per week of age
5. Prior preterm labor
6. Urinary tract infection (UTI)
7. Bacterial vaginosis
8. Vaginal pH >4.5
Signs of preterm labor
 Uterine contractions and cramps
 Vaginal discharge
 Bleeding
 Backache
 Leaking of amniotic fluid
Treatment of preterm labor

1. Bed rest
2. Hydration: 500 ml of balanced electrolyte solution, such as Ringers lactate IV
over 30 min.peroid. Hydration is continued at a rate of at least 125 ml/hour.
3. Tocolytics
A. Magnesium sulfate: as high conc. have been shown to decrease uterine activity.
The dose is 6 g IV as bolus dose in 250 ml of sol. over 30 min. period; the infusion
is then maintained at 2-4 g /hr.
B. β- Mimetic drugs: like ritodrine as it causes uterine relaxation is administered
IV and slowly titrated upward until a response is achieved. The dose is 100 μ
/min. IV, with increases of 50 μ/min.every 10 min to a max of 350ug/min.
4. Glucocorticosteroid: these drugs are administered for the reduction of
respiratory distress syndrome in preterm infants.
The mechanism by which these drugs decrease lung disease is enzyme induction
in type II pneumocytes of increased production of surfactant, which in turn
reduces alveolar surface tension. All women between 24 and 34 weeks of
pregnancy at risk for preterm delivery are candidates for antenatal corticosteroid
therapy.
Treatment should consist of either Tow doses of 12 mg of
Betamethasone IM 24 hours apart or 4 doses of 6 mg of
Dexamethasone IM 12 hours apart. Some benefit begins at 24 hours,
with a maximum benefit at 48 hours after imitation of therapy and lasting for 7
days. Treatment is given weekly until fetal maturity.
5. Group B Streptococcus treatment: Premature infants are very susceptible to

early GBS infections. So the use of Pencillin is recommended. 54
6. Calicum Channel Blockers: these drugs have been used for preterm labor as
Nifedipine, Nicardipine and Verapamil as they inhibit contractions. Dosage of
nifedipine is 10-20 mg every 4-6 hours orally sublingually in the first hour,
followed by 60-160 mg/day of slow-release nifedipine.
Prevention of pre-term labor
• Progesterone
• Studies have demonstrated that progesterone given to women
with a history of spontaneous preterm birth can effectively
decrease the incidence of recurrent preterm birth in a subsequent
pregnancy.
• The optimal formulation for this indication has not been

identified, but the most commonly used agent, based on data from
the largest clinical trial, is 17-Hydroxyprogesterone caproate.
• Dose: 250 mg IM weekly initiated at 16 to 20 weeks of

gestational age and continued until 37.

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Caesarean section (C/S)

• However, the following minor complications can occur in women having

Treatment of preterm labor

5. Group B Streptococcus treatment: Premature infants are very susceptible to

• The optimal formulation for this indication has not been

• Dose: 250 mg IM weekly initiated at 16 to 20 weeks of

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