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
    • the shortest duration of treatment that can result in harm to the fetus is not known
  • 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)
    • 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

More general terms

• labor
• complications of labor & delivery

Additional terms

• preterm delivery