Preterm labor

Diagnosis

Healthcare provider will conduct full physical assessment, assess for signs and symptoms, review the medical background, and risk factors for preterm labor. Preterm labor will probably be identified if the patient has regular uterine contractions and their cervix has started to soften, thin, and open (dilate) before 37 weeks of pregnancy.

Preterm labor is diagnosed using several tests and procedures, such as:

• Physical Examination: A pelvic examination will be performed by a healthcare provider to assess the baby’s size and location as well as the uterus firmness and tenderness. Healthcare provider may also perform a pelvic exam to see if the cervix has started to open if their water has not burst.
• Ultrasound: an ultrasound may be performed to determine the baby’s weight, confirm the position of the baby, determine the amount of amniotic fluid present, and evaluate for any issues with the placenta or infant.
• Uterine monitoring: This device will be used to record the length and interval of the contractions.
• Laboratory tests: To screen for the presence of specific infections and fetal fibronectin, which serves as a glue between the fetal sac and the lining of the uterus and is released during labor, the healthcare provider will perform swabbing of the vaginal secretions. These findings will be evaluated in conjunction with additional risk variables. Additionally, patient will need to undergo urinalysis to examine for any presence of particular germs.

Treatment

Preventive treatment

• Cervical cerclage: This surgical procedure is recommended if the cervix of the patient is short. Strong sutures are used in this operation to closure the cervix. After 36 weeks of pregnancy, the sutures are removed. The sutures can also be removed sooner if necessary.

In the event that the mother is less than 24 weeks pregnant, have a history of premature birth, have an ultrasound that reveals that their cervix is opening, or have a cervical length less than 25 millimeters, a cervical cerclage may be advised.

• Preventive medication: Healthcare provider may recommend weekly injections of hydroxyprogesterone caproate, a progesterone hormone starting second trimester and continuing up until week 37 of pregnancy if the mother have a history of premature birth.

Progesterone injections into the vagina may also be recommended as a preventative step against preterm birth. The use of progesterone up until week 37 of pregnancy may also be advised if the patient are identified as having a short cervix before week 24 of pregnancy.

Patient will experience another preterm labor if the patient have history of premature labor. Management of any risk factors and deal with any early warning symptoms in cooperation with the healthcare provider.

Medications

There are no drugs or surgical techniques that can permanently stop labor once it has started.

Healthcare provider may need to plan a weekly or more regular appointments with the patient if they are not going to be hospitalized, this is to monitor for any preterm labor signs and symptoms.

Healthcare provider might suggest one of the following drugs:

• Corticosteroids: Healthcare provider will probably recommend corticosteroids if the patient is between 23 and 34 weeks pregnant and their doctor believes they are at risk of giving birth within the following one to seven days. If they have the chance of giving birth between 34 and 37 weeks, their doctor might also advise taking steroids. If the patient are less than 34 weeks pregnant, at risk of giving birth within seven days, and they already received corticosteroids more than 14 days, then they can be prescribed another set of these medications.
• Magnesium sulfate: This medication will be recommended if the patient have a high chance of giving birth between weeks 24 and 32 of pregnancy. For infants born prior to 32 weeks of gestation, some study suggests that it may lessen the chance of a certain type of brain injury (cerebral palsy).
• Tocolytics: There is no evidence that using tocolytics will improve the health of newborns in general or treat the underlying causes of premature labor. These medications will temporarily slow the contractions. Tocolytics may be administered for up to 48 hours to postpone preterm labor so that corticosteroids can work to their full potential.

If a patient has certain disorders, such as high blood pressure caused by pregnancy, a healthcare provider will not recommend a tocolytic.