Table 1. Definition of appropriate use of interventions, based on WHO recommendations*.
Domain | ACS | Tocolytics | Magnesium sulphate | Antibiotics |
---|---|---|---|---|
Who | Women at risk of imminent preterm birth (birth is predicted to occur within 7 days starting treatment) with no clinical evidence of infection | Women at risk of imminent preterm birth who are eligible for ACSs administration | Women at risk of imminent preterm birth | Women with PPROM |
When | Gestational age from 24 to 34 weeks accurately assessed through ultrasound dating | N/A | Gestational age less than 32 weeks assessed by ultrasound dating | After a definitive diagnosis of PPROM |
Where | Health facility where adequate childbirth and preterm newborn care are available (including resuscitation, thermal care, feeding support, infection treatment, and safe oxygen use) | Health facility where adequate childbirth is available | Health facility where adequate childbirth is available | Health facility where adequate childbirth is available |
How | Intramuscular dexamethasone or betamethasone (24 mg in divided doses). Single repeat course can be administered if birth does not occur within 7 days of initial dose and there is high risk of preterm birth in the next 7 days | Nifedipine (a calcium channel blocker) is the preferred agent, administered as 10–30 mg initial dose, followed by 10–20 mg every 4–8 hours up to 48 hours or until referral complete | Administer prior to birth or up to 24 hours prior to anticipated birth | Erythromycin-recommended regimen |
*Adapted from WHO recommendations on interventions to improve preterm birth outcomes: evidence base [12]; N/A, not applicable.
ACS, antenatal corticosteroid; PPROM, preterm prelabour rupture of membranes; WHO, World Health Organisation.