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Preterm Labor - Treatment Overview
SYMPTOMS & TREATMENTS
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. The closer the baby is to full term and the more a baby weighs, the better the baby's chances of surviving and avoiding complications.
- 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). If there is a good chance that you could be transferred to a hospital with a NICU before the birth, your doctor may try to slow labor. If the baby is born before you are transferred, he or she may be transferred after birth if necessary.
- 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, to prevent 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.5
- 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 proof that long-term bed rest lowers the risk of preterm delivery.6 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.7 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. Cerclage is meant to stop the cervix from opening early, which could lead to miscarriage or preterm birth. It is not used to treat preterm labor. But 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.1
| By: | Healthwise Staff | Last Revised: January 10, 2011 |
| Medical Review: | Sarah Marshall, MD - Family Medicine William Gilbert, MD - Maternal and Fetal Medicine | |
© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
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