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premature labor; preterm labor
Etiology:
- risk factors
- pregnant with twins, triplets ...
- previous premature birth
- uterine or cervical pathology
- urinary tract infections
- vaginal infections
- sexually transmitted infections
- fever (> 101 degrees F) during pregnancy
- unexplained vaginal bleeding after 20 weeks of pregnancy
- hypertension
- renal disease
- diabetes mellitus
- dehydration
- multiple first trimester abortions or one or more second trimester abortions
- nderweight or overweight before pregnancy
- hypercoagulability
- pregnancy with a single fetus after in vitro fertilization
- short time between pregnancies (< 6-9 months between birth & beginning of the next pregnancy)
- little or no prenatal care
- smoking
- alcoholic beverages
- illicit drugs
- domestic violence, including physical, sexual or emotional abuse
- lack of social support
- high levels of stress
- low income
- long working hours with long periods of standing
Clinical manifestations:
- contractions every 10 minutes, or more frequently within 1 hour (5 or more uterine contractions/hour)
- vaginal discharge of watery fluid (amniotic fluid)
- menstrual-like cramps (constant or intermittent)
- low, dull backache below the waistline (constant or intermittent)
- pelvic pressure
- diarrhea may occur with cramping
Management:
- self help
- empty bladder
- lie down on left side
- may slow down or stop signs & symptoms
- supine position may cause the contractions to increase
- ensure adequate hydration
- monitor contractions for 1 hour
- if symptoms do not improve after 1 hour, call health care provider or go to hospital
- professional mangagement:
- MgSO4 IV
- administration of MgSO4 to pregnant women longer than 5-7 days may lead to low calcium levels & bone problems in the developing fetus [1]
- the shortest duration of treatment that can result in harm to the fetus is not known [1]
- corticosteroid given 24 hours before birth may help accelerate fetal lung & brain maturity
- a single course of corticosteroids in women at 24-37 weeks gestation expected to go into labor soon (ruptured membranes, multiple gestation) [2]
- consider corticosteroids in women at 23 weeks gestation at risk for delivery.
- prognosis
- many women go on to have normal pregnancy, labor & delivery
- most babies born prior to 24 weeks have little chance of survival
- babies born after 32 weeks have a very high survival rate, & usually do not have long term complications
Related
preterm delivery
General
labor
complications of labor & delivery
References
- FDA MedWatch. May 30, 2013
Magnesium Sulfate: Drug Safety Communication - Recommendation
Against Prolonged Use in Pre-term Labor
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm354603.htm
- American College of Obstetricians and Gynecologists (ACOG)
Committee on Obstetric Practice.
Antenatal Corticosteroid Therapy for Fetal Maturation.
ACOG Committee Opinion Number 677, October 2016
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Antenatal-Corticosteroid-Therapy-for-Fetal-Maturation
- American Pregnancy Association: Premature Labor
http://www.americanpregnancy.org/labornbirth/prematurelabor.html
- Sutter Health: Premature Labor
http://www.babies.sutterhealth.org/during/preg_prematurelabor.html
- March of Dimes: Preterm Labor
http://www.marchofdimes.com/pregnancy/preterm_indepth.html