Are there any circumstances where suppressing labour is not a good idea?
Yes. However preterm the labour might be, no attempt to suppress it will be made in the presence of:
Severe vaginal bleeding
Infection affecting the pregnancy itself (chorioamnionitis)
Fetal abnormalities incompatible with life.
As has been mentioned before, if the gestation is over 34 weeks, in most instances labour won't be suppressed. However, there is room for flexibility here and assessment may lead to a decision to try to prolong labour if it is perceived that the fetus is likely to benefit from this.
What are the drugs used to suppress preterm labour and what are their potential side-effects?
There are various types of drugs used to suppress labour. Over a long time, most popular type by far has been the group of drugs known in medical parlance as ‘beta-agonists’ (ß-agonists). The side-effects of these include palpitations, lung congestion and occasionally chest pains, rising blood sugar levels (hence great care is needed if the patient is diabetic), and lowering blood pressure. Of these, the most common and most vexing, as far as the patient is concerned, is palpitations. The most serious (and fortunately rare) one is lung congestion (oedema). Nifedipine (below) is gradually replacing beta-agonist as a drug of choice for suppressing labour.
Atosiban (an antagonist of oxytocin) is another agent used to suppress labour. It is not more effective than beta-agonists but is claimed to have fewer and milder side-effects. Other remedies employed, with modest effectiveness include rapid intravenous hydration and even the drug magnesium sulphate. All these are meant to buy just a few days at most. No drug has been shown to have long term effectiveness and therefore, there is no place for maintenance labour suppression therapy. It does not work.
Labour-suppressing drugs are collectively called ‘tocolytics’.
If delivery was inevitable, what would be the method of delivery?
As with all deliveries, term or preterm, the method of delivery is dependent on a lot of factors, and preterm labour in itself does not dictate this one way or the other.
As a general statement, in the absence of contraindicating factors, the aim will be for a vaginal delivery in preterm labour. If the baby is in the breech position, this general plan may have to be reviewed. This does not mean preterm breech babies are not delivered vaginally. It only means a careful evaluation on the best method of delivery needs to be done by the obstetrician.
Will forceps be used to deliver the baby, if it is a vaginal delivery?
This is no longer considered to offer any advantage to the premature baby and will therefore be used only if there are any of the usual indications for using forceps. The ventouse is not used, certainly not before thirty-four weeks, after which it can be used for the usual indications.
Do any potential maternal complications result from preterm delivery?
There is a slight increase in the risk of retaining the afterbirth, thus requiring surgical removal in theatre. Probably the potential problem which creates most concern among prospective or new parents is the interruption in the mother-baby bonding.
The baby, if needing intensive care, will be transferred to the special care baby unit. In some cases, if facilities are inadequate or unavailable at the local hospital, the baby may have to be transferred to another hospital further away. Efforts are usually made to maximize access of the parents to the baby. Breast-feeding, when and if possible, is encouraged.