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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Preterm Labor and Preterm Premature Rupture of Membranes
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14. A.C.O.G. Resources
What is the latest A.C.O.G. statement on this?
Management of preterm labor.
ACOG Practice Bulletin No. 43. American College of Obstetricians and Gynecologists. Obstet Gynecol 2003; 101:1039-47.
Summary of Recommendations
The following recommendations are based on good and consistent scientific evidence (Level A):
- There are no clear "first-line" tocolytic drugs to manage preterm labor. Clinical circumstances and physician preferences should dictate treatment.
- Antibiotics do not appear to prolong gestation and should be reserved for group B streptococcal prophylaxis in patients in whom delivery is imminent.
- Neither maintenance treatment with tocolytic drugs nor repeated acute tocolysis improve perinatal outcome; neither should be undertaken as a general practice.
- Tocolytic drugs may prolong pregnancy for 2-7 days, which may allow for administration of steroids to improve fetal lung maturity and the consideration of maternal transport to a tertiary care facility.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Cervical ultrasound examination and fetal fibro- nectin testing have good negative predictive value; thus, either approach or both combined may be helpful in determining which patients do not need tocolysis .
- Amniocentesis may be used in women in preterm labor to assess fetal lung maturity and intraamniotic infection.
- Bed rest, hydration, and pelvic rest do not appear to improve the rate of preterm birth and should not be routinely recommended.
Assessment of Risk Factors for Preterm Birth
ACOG Practice Bulletin No. 31. American College of Obstetricians and Gynecologists. Obstet Gynecol . 2001 Oct ;98 (4):709-16.
Summary of Recommendations
The following recommendation is based on good and consistent scientific evidence (Level A):
- There are no current data to support the use of salivary estriol , HUAM, or BV screening as strategies to identify or prevent preterm birth
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Screening for risk of preterm labor by means other than historic risk factors is not beneficial in the general obstetric population.
- Ultrasonography to determine cervical length, fFN testing, or a combination of both may be useful in determining women at high risk for preterm labor. However, their clinical usefulness may rest primarily with their negative predictive value given the lack of proven treatment options to prevent preterm birth.
- Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention.
Use of Progesterone to Reduce Preterm Birth
ACOG Committee Opinion, Number 291, November 2003
ABSTRACT: Preterm birth affects 12% of all births in the United States. Recent studies support the hypothesis that progesterone supplementation reduces preterm birth in a select group of women (ie, those with a prior spontaneous birth at <37 weeks of gestation). Despite the apparent benefits of progesterone in this high-risk population, the ideal progesterone formulation is unknown. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice believes that further studies are needed to evaluate the use of progesterone in patients with other high-risk obstetric factors, such as multiple gestations, short cervical length, or positive test results for cervicovaginal fetal fibronectin. When progesterone is used, it is important to restrict its use to only women with a documented history of a previous spontaneous birth at less than 37 weeks of gestation because unresolved issues remain, such as optimal route of drug delivery and long-term safety of the drug.
