Preterm Labor

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 think about:

• 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 4 centimeters, tocolytic medicine 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 medicines 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 medicine 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 medicine is the current treatment. If effective, tocolytics may delay birth for more than 48 hours.⁶
• Treat or prevent infection with antibiotics.
• Help the fetus's lungs mature quickly with antenatal corticosteroids (given to you). These medicines take 24 to 48 hours to benefit the fetus.

There is no evidence that long-term bed rest lowers the risk of preterm delivery.⁷ But your doctor may advise you to take it easy and try to rest as much as possible. Studies have shown that strict bed rest for 3 days or more may increase your risk of getting a blood clot in the legs or lungs.⁸ Strict bed rest is no longer used to prevent preterm labor. But if your doctor has recommended expectant management with some bed rest (partial bed rest), remember to flex your feet, stretch, and move your legs as much as possible.

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. For a woman who has had a preterm birth in the past because her cervix did not stay closed, cervical cerclage may prevent another preterm birth.²

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 medicines can be effective for delaying delivery for 1 to 2 days so that other medicine (antenatal corticosteroids) can be given to help the fetus's lungs mature. But there is no evidence that tocolytic medicines prolong pregnancy or improve infant survival when given for longer periods of time.⁷ They can also have serious side effects on the mother, the fetus, or both. For more information, see the Medications section of this topic.

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

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Author:	Sandy Jocoy, RN	Last Updated: January 14, 2009
Medical Review:	Sarah Marshall, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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