How should I manage a patient presenting with preterm labour at 32 weeks gestation?

Management of a patient presenting with preterm labour at 32 weeks of gestation includes:

• Confirm diagnosis through clinical assessment including speculum or digital vaginal examination to rule out established labour and confirm suspected or diagnosed preterm labour. ¹
• Provide the woman with clear information and support about the symptoms, care options, and potential outcomes for both mother and baby, including neonatal care and long-term consequences of prematurity. ¹
• Administer intravenous magnesium sulfate for neuroprotection of the baby, as the patient is between 30+0 and 33+6 weeks and in established preterm labour or likely to deliver within 24 hours. The regimen is a 4 g IV bolus over 15 minutes followed by 1 g per hour infusion until birth or 24 hours, whichever is sooner. Monitor for magnesium toxicity regularly. ¹
• Consider administration of maternal corticosteroids to enhance fetal lung maturation, as per local protocols and clinical judgement (implied by standard preterm labour management though not explicitly detailed in the excerpt). ¹
• Discuss mode of birth, explaining benefits and risks of vaginal versus caesarean birth at this gestation, noting no clear benefit or harm to the baby from caesarean but increased risks associated with preterm caesarean birth. Consider caesarean if breech presentation is present. ¹
• Delay cord clamping for at least 60 seconds after birth unless immediate clamping is required for maternal or fetal reasons, positioning the baby at or below placenta level before clamping. ¹
• Involve senior obstetricians in decisions about fetal monitoring and management, and provide ongoing support and information to the woman and her family. ¹