Preterm Labor and PPROM

Preterm labor and preterm premature rupture of membranes (PPROM) require systematic clinical evaluation and targeted interventions to optimize neonatal outcomes. Diagnosis of preterm labor necessitates confirming both contractions and cervical change before 37 weeks, utilizing sterile speculum exams to collect cultures and fetal fibronectin—a test with high negative predictive value but significant contamination risks. Management strategies include administering betamethasone for fetal lung development, magnesium sulfate for neuroprotection before 32 weeks, and penicillin for GBS prophylaxis. Tocolytics like indomethacin or nifedipine help delay delivery to facilitate these interventions. Conversely, PPROM management prioritizes latency antibiotics and avoiding digital cervical exams to mitigate infection risks, with tocolytics generally contraindicated. These protocols aim to stabilize the fetus and prevent complications like cerebral palsy and necrotizing enterocolitis, balancing the need for gestation prolongation against the risks of subclinical infection.