Labour that start after 20 weeks but before completion of 37 weeks from the last menstrual period.


  • Previous history of spontaneous abortion
  • Polyhydramnios 
  • Pre-eclampsia 
  • APH in present pregnancy
  • Medical or surgical illness & operation 
  • Substance abuse 
  • Present and past obstetric problems
  • Infection like TORCH 
  • Intra uterine death, multiple pregnancies, placental abnormality  

  • Uterine contractions (painful or painless)
  • Abdominal cramping may be with diarrhea 
  • Low back pain with pelvic pressure or heaviness 
  • Thicker, bloody, brown or colorless odorous discharge from vagina

  • Cervical dilation more than 2 cm 
  • Cervical effacement 
  • Regular uterine contraction more than 4 times per hour 
  • Funneling of internal Os
  • Vaginal discharge 

  • Advice to take rest in a left-lateral position or supine with a wedge under the right hip to prevent hypotension.
  • The women's physical & psychological rests are the highest priority, as anxiety is known to compromise uterine blood flow.
  • Give toolytic drugs (any agent that diminished uterine contractions by reducing myometrial excitability) to hold/reduce the labour pain, like ritodrine.
  • Administer corticosteroids to stimulate fetal pulmonary surfactant production.
  • Uterine activity is monitored continuously.
  • Vital signs and FHR are checked every 15 minutes.
  • Maternal pulse should not exceed 140/min and FHR should not exceed 180 bpm.
  • Fetal fibronectin enzyme immunoassay may be carried out on a sample of vaginal secretions taken from the posterior vaginal fornix.
Fetal Fibronectin Assay:

  • A screening test that identifies the probability of preterm labor.
  • Fibronectin is usually found in cervicovaginal fluid during the first 20 weeks and after 34 weeks of pregnancy.
  • Fibronectine protein binds deciduas with fetal membrane.
  • A positive test result (presence of fibronectin protein between 20 to 34 weeks of pregnancy) in women with symptoms of threatended preterm labor indicates the probability of delivery within 1 week.


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