An appropriate standard of childbirth care should be available to the mother in a facility that has a team of health-care providers competent in recognizing and safely managing preterm labour and imminent preterm birth. Safe care during labour and childbirth requires clode monitoring of the mother and fetus to identify and appropriately manage complication, such as maternal infection and fetal hypoxia
Due to consideration should be given to local limit of gestational age when antenatal steroids should be administered, including reference to local data on newborn survival and morbidity. The probability of survival without residual morbidity (“intact survival”) at<24 weeks is low, even in high-resource settings.
Antenatal corticosteroid therapy:
Accurate and standardized gestational age assessment (ideally from first trimester ultrasound) is essential to ensure that all eligible mothers receive corticosteroids while avoiding unnecessary treatment of ineligible mothers. Antenatal corticosteroid should not be routine administered in situations where the gestational age cannot be confirmed, particularly when gestational age is suspected to be more than 34 weeks, as the risk of harm may outweigh the benefits if mature fetuses are exposed to corticosteroid in utero.
Antenatal corticosteroid therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following condition are met:
- Gestational age assessment can be accurately undertaken
- Preterm birth is considered imminent
- There is no clinical evidence of maternal infection
- Adequate child birth care is available
- The preterm newborn can receive adequate care if needed
The recommendations on interventions to improve preterm birth outcomes:
- For the mother, the recommendation relate to the use of antenatal corticosteroids, tocolysis, magnesium sulfate, antibiotics and optimal mode of delivery of preterm newborns.
- For the preterm infants, they relate to the use of Kangaroo mother care, plastic wraps, continuous positive airway pressure therapy, surfactan replacement therapy and oxygen therapy