ACOG PRACTICE BULLETIN NO.127 MANAGEMENT OF PRETERM LABOR PDF

Fretts, MD; Uma M. Turrentine, MD. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable such as smoking , many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth.

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Topic Overview Is this topic for you? This topic covers how preterm labor affects the pregnant woman. If you want to know how it affects the baby after he or she is born, see the topic Premature Infant. What is preterm labor? Preterm labor is labor that comes too early—between 20 and 37 weeks of pregnancy. In labor, the uterus contracts to open the cervix. This is the first stage of childbirth.

Preterm labor is also called premature labor. What are the risks of preterm labor and preterm birth? The earlier a baby is delivered, the higher the chances are that he or she will have serious problems. For infants born before 24 weeks of pregnancy, the chances of survival are extremely slim.

Many who do survive have long-term health problems. They may also have trouble with learning and talking and with moving their body poor motor skills.

What causes preterm labor? Causes of preterm labor include: The placenta separating early from the uterus. This is called placenta abruptio. Being pregnant with more than one baby, such as twins or triplets. Problems with the uterus or cervix. Drug or alcohol use during pregnancy. Sometimes a doctor uses medicine or other methods to start labor early because of pregnancy problems that are dangerous to the mother or her baby. What are the symptoms? It can be hard to tell when labor starts, especially when it starts early.

So watch for these symptoms: Regular contractions for an hour. This means about 6 or more in 1 hour, even after you have had a glass of water and are resting. Leaking or gushing of fluid from your vagina. You may notice that it is pink or reddish. This is called a rupture of membranes, also known as your water breaking. When it happens before 37 weeks of pregnancy, it is called preterm prelabor rupture of membranes, or pPROM.

Pain that feels like menstrual cramps, with or without diarrhea. A feeling of pressure in your pelvis or lower belly. Your belly may hurt when you press on it. If your contractions stop, they may have been Braxton Hicks contractions. These are a sometimes uncomfortable—but not painful—tightening of the uterus. They are like practice contractions. But sometimes it can be hard to tell the difference.

How is preterm labor diagnosed? If you think you have symptoms of preterm labor, call your doctor or certified nurse-midwife. He or she can check to see if your water has broken, if you have an infection, or if your cervix is starting to dilate. You may also have urine and blood tests to check for problems that can cause preterm labor.

You may have a painless swab test for a protein in the vagina called fetal fibronectin. How is it treated? If you are in preterm labor, your doctor or certified nurse-midwife must compare the risks of early delivery with the risks of waiting to deliver.

Depending on your situation, your doctor or midwife may: Try to delay the birth with medicine. This may or may not work. Use antibiotics to treat or prevent infection. If your amniotic sac has broken early, you have a high risk of infection and must be watched closely. Treat any other medical problems causing trouble in pregnancy. Allow the labor to go on because delivery is safer for the mother and baby than letting the pregnancy go on.

Cause Preterm labor can be caused by a problem involving the baby, the mother, or both. Often a combination of several factors is responsible. Women who are pregnant with more than one baby have an increased risk of complications—both for the mother and the babies—and typically deliver early.

Infection, which can trigger uterine contractions and preterm prelabor rupture of membranes pPROM. This may include: Infections that begin in the vagina, such as bacterial vaginosis BV. Infections that begin in the urinary tract, such as a urinary tract infection. Placenta abruptio. This is the early separation of the placenta from the uterus.

The use of drugs such as cocaine or methamphetamine. Problems with the uterus or cervix, such as: A weak, thin cervix. An abnormally shaped uterus. Symptoms Preterm labor often starts without obvious symptoms.

But you may notice one or more symptoms, including: Menstrual-like cramps, with or without diarrhea. A persistent, dull ache in your lower back, pelvic area, lower belly, or thighs. Changes in your vaginal discharge, which may increase in amount or become pink or reddish.

Regular contractions. Not feeling well. Feeling unusually tired. Feeling pain in your belly when you press on it. It is sometimes hard to tell the difference between Braxton Hicks contractions and preterm labor contractions. You may have one or more of these symptoms and not be in preterm labor. But if you are concerned, talk to your doctor or nurse-midwife. What Happens If preterm labor occurs close to your due date in the 35th or 36th week of pregnancy , you may be allowed to deliver without delay.

Your doctor may be able to stop your preterm labor. Premature infant A baby born too early may have complications, such as bleeding in the brain or chronic lung disease.

The earlier a baby is born, the higher the risk. Your doctors can prepare you for what may lie ahead. They can base this on your condition and how many weeks pregnant you will be when you give birth. Thanks to improved medical care, more premature infants are surviving today than in years past. For more information, see the topic Premature Infant.

What Increases Your Risk A risk factor is anything that increases your chances of having a problem. Risk factors related to your pregnancy Pregnancy with twins, triplets, or more. Infection in the urinary or reproductive tract, including the vagina. Risk factors related to your medical history A past preterm delivery. Previous surgery on your cervix , such as a cone biopsy.

Having a loop electrosurgical excision procedure LEEP also may increase preterm labor risk. Cigarette smoking during pregnancy. Use of cocaine or methamphetamine. When should you call your doctor? Preterm labor can be hard to recognize. Get the earliest possible medical care by calling your doctor or your nurse-midwife about signs of preterm labor.

Anytime during your pregnancy Call your doctor or your nurse-midwife if: Your water breaks. You have bleeding or spotting from your vagina.

You have painful or frequent urination or your urine is cloudy, foul-smelling, or bloody. Between 20 and 37 weeks of your pregnancy Call your doctor, your nurse-midwife, or the labor and delivery unit of your local hospital if: You have had regular contractions for an hour.

You have unexplained low back pain or pelvic pressure. You have symptoms of infection. For example: Your belly hurts when you press on it. You feel unusually tired. You have intestinal cramps. The baby has stopped moving or is moving much less than normal.

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Practice Bulletin No. 159: Management of Preterm Labor.

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