Preterm Labor: Treatment Overview

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Treatment Overview

Treatment to slow your preterm labor contractions may be used if:

• You are between 23 and 34 completed weeks of pregnancy.
• You are having regular contractions. This means about 4 or more in 20 minutes, or about 8 or more within 1 hour, even after you have had a glass of water and are resting.
• Your cervix has opened (dilated) to more than 2 centimeters and has begun to thin (efface).

Preterm labor is not always treated. When a pregnancy is nearing term (about 37 or more weeks), or when the mother or her fetus has a serious medical problem, preterm labor is usually allowed to continue until delivery.

When deciding on the amount and type of treatment, your doctor or nurse-midwife will consider:

• Your baby's weight and age. Ideally, preterm labor is delayed until a baby is mature enough that complications after birth are unlikely.
• Your health. Very high blood pressure, severe preeclampsia, HELLP syndrome, chronic disease, infection, or heavy bleeding can make it necessary to deliver immediately, rather than try to delay a birth.
• Your baby's health. Signs of fetal distress or illness can make it necessary to deliver immediately, rather than try to delay a birth.
• Whether your amniotic sac has ruptured (preterm premature rupture of membranes, or pPROM).
• The stage of your labor and its rate of progression. For example, when your cervix is well effaced (thinned) and dilated (opened) beyond , tocolytic medication to slow labor is less likely to be effective.
• The distance to a neonatal intensive care unit (NICU). Impending labor may be delayed for transport to a hospital with an NICU.
• The benefit of the tocolytic medications used to delay labor versus their risks to you and your baby.

If you are treated for preterm labor

Preterm labor is usually treated in the hospital, in the labor and delivery area. Whether your amniotic membranes have ruptured before contractions start (preterm premature rupture of membranes, or pPROM) or after contractions have begun (spontaneous rupture of membranes, or SROM), you will be admitted directly to the labor and delivery unit. If rupture of membranes has not occurred, you will be observed for at least an hour or two to see whether your contractions continue and your cervix changes (opens and thins).

• If your cervix does not change, or if your contractions stop or slow down, you may be sent home.
• If your cervix changes, you will be admitted to the labor and delivery unit.

If you are admitted to the labor and delivery unit, your doctor or nurse-midwife may choose to:

• Use medication to try to slow or stop the contractions, thus preventing the cervix from opening wider (dilating) or becoming thinner (effacing). Short-term treatment with tocolytic medication is the current treatment. If effective, tocolytics may delay birth for more than 48 hours.¹⁰
• Treat or prevent infection with antibiotics.
• Help the fetus's lungs mature quickly with antenatal corticosteroids (given to you). These medications take 24 to 48 hours to benefit the fetus.

What To Think About

Dehydration is a common cause of temporary preterm contractions. At the first sign of possible contractions, be sure to drink extra fluids. If dehydration is the cause, your contractions should subside.

Tocolytic medications can be effective for delaying delivery for 1 to 2 days so that other medication (antenatal corticosteroids) can be given to help the fetus's lungs mature. However, there is no evidence that tocolytic medications prolong pregnancy or improve infant survival when given for longer periods of time.¹¹ They can also have serious side effects on the mother, the fetus, or both. For more information, see the Medications section of this topic.

Treatments that do not work for preterm labor

• Bed rest (expectant management) Strict bed rest for 3 days or more increases your risk of developing a blood clot in the legs or lungs (from 1 in 1,000 to 16 in 1,000).¹² There is no evidence that long-term bed rest lowers the risk of preterm delivery.^{13 11}
• Cervical cerclage Cervical cerclage is the placement of stitches in the cervix to hold it closed. It is rarely done. Cerclage is meant to stop the cervix from opening early, which could lead to miscarriage or preterm birth. It has helped some high-risk pregnancies last longer, but cerclage also has risks—it can cause infection or miscarriage. Studies suggest that cerclage makes twin pregnancies more likely to deliver early. Experts do not yet know when cerclage is more likely to work and when it isn't.¹⁴
• Home fetal monitoring Research has shown that home monitoring is expensive and has no proven effect on delaying early birth.^{15 11}

For information about having a premature infant, see the topic Premature Infant.

How can I make informed decisions about my extremely premature infant?

Last updated:	January 19, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Kathleen Romito, MD - Family Medicine, William Gilbert, MD - Perinatology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC