Survival of the Fittest (Littlest) - Management of a High Risk Pregnancy?

Preterm labour (PTL) is one of the leading causes of perinatal morbidity and mortality. Incidence: The overall incidence of PTL is around 10 - 15% (6 - 15% Range) 3. Risk factors: Previous history of preterm labour is one of the important risk factor and risk of PTL in subsequent pregnancies is 14.3% and 28% after one and two preterm births. Others include multiple pregnancy, uterine over distension (polyhydramnios, macrosomia and fibroids), uterine anomalies, cervical incompetence, bacterial vaginosis, bleeding in early pregnancy, poor socioeconomic status, elderly and adolescent age group and tobacco use. Predictors: Cervical length assessment by USG, fetal fibronectin, vaginal pH are being used. Prevention: Progesterone and clindamycin (abnormal vaginal flora) antibiotic is being used with reasonable evidence. Better Prognosis: Corticosteroids and antibiotics help in reducing neonatal morbidity and mortality and tocolytics helps in allowing the steroids to act. Conclusion: Successful prediction, prevention and treatment of preterm labour has significant influence on the perinatal outcome, health care expenditure and quality of life. We have successfully managed a case of preterm in this case report and the preterms have successfully survived .