Acrobat
MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Preterm Labor and Preterm Premature Rupture of Membranes
Sponsored by The Indian Health Service Clinical Support Center
13. Other Online Resources and Patient Education
National Guidelines Clearinghouse
Many practice guidelines compiled by the Agency for Healthcare Research and Quality . Once at the link above, search for Preterm Labor and Preterm Premature Rupture of Membranes
PubMed
Once at the PubMed, search for: Preterm Labor or Preterm Premature Rupture of Membranes and American Indians
Agency for Research Quality and Healthcare
Management of Preterm Labor: Summary
Evidence Report/Technology Assessment: Number 18
AHRQ Preterm Labor: Clinical Focus
Management of Preterm Labor
Evidence Report/Technology Assessment: Number 18
Conclusions. Based on the literature reviewed, two biologic markers (fFN and EVUSD) are found to be quite useful in identifying women in preterm labor who are at low risk of experiencing a preterm birth. Although the evidence remains mixed, certain tocolytics-beta- mimetics, calcium channel blockers, magnesium sulfate, and NSAIDs-appear effective in prolonging pregnancy when used as first-line agents in arresting preterm labor, but beta- mimetics in comparison with other tocolytics seem to present a higher risk of maternal harms. Ethanol is not found to be an appropriate tocolytic agent. Tocolytics are not useful as maintenance interventions. Antibiotics for suspected genital tract infections may be useful. Home uterine activity monitoring was found to confer no maternal or fetal/neonatal benefits.
The literature concerning the management of preterm labor is flawed in several ways relating largely to definitions of preterm labor, appropriate measures of outcomes, and use of survival analysis. Epidemiologic research as well as additional efficacy and effectiveness studies of the two biologic markers, selected tocolytics, and antibiotics are warranted.
This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.
US Preventive Services Task Force (USPSTF)
Guide to clinical preventive services . 2nd ed ; Baltimore (MD): Williams & Wilkins; 1996. Screening Ultrasonography in Pregnancy
CLINICAL INTERVENTION
Routine ultrasound examination of the fetus in the third trimester is not recommended, based on multiple trials and meta-analyses showing no benefit for either the pregnant woman or her fetus ("D" recommendation). There is currently insufficient evidence to recommend for or against a single routine midtrimester ultrasound in low-risk pregnant women ("C" recommendation). These recommendations apply to routine screening ultrasonography and not to diagnostic ultrasonography for specific clinical indications (e.g., follow-up evaluation of elevated maternal serum alpha-fetoprotein).
Cochrane Library
King J, Flenady V, Cole S, Thornton S. Cyclo-oxygenase (COX) inhibitors for treating preterm labour.
The Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001992.pub2. DOI: 10.1002/14651858.CD001992.pub2
Main results: This review includes outcome data from 13 trials with a total of 713 women. The non-selective COX inhibitor, indomethacin was used in 10 trials. When compared with placebo, COX inhibition (indomethacin only) resulted in a reduction in birth before 37 weeks' gestation (relative risk (RR) 0.21; one trial, 36 women), an increase in gestational age (weighted mean difference (WMD) 3.53 weeks) and birthweight (WMD 716.34 gm; two trials, 67 women). Compared to any other tocolytic, COX inhibition resulted in a reduction in birth before 37 weeks' gestation (RR 0.53; three trials, 168 women) and a reduction in maternal drug reaction requiring cessation of treatment (RR 0.07; five trials and 355 women).
Authors' conclusions: There is insufficient information on which to base decisions about the role of COX inhibition for women in preterm labour. Further well designed trials are needed.
Anotayanonth S, Subhedar NV, Garner P, Neilson JP, Harigopal S. Betamimetics for inhibiting preterm labour.
The Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004352.pub2. DOI: 10.1002/14651858.CD004352.pub2.
Authors' conclusions: Betamimetics help to delay delivery for women transferred to tertiary care or completed a course of antenatal corticosteroids. However, multiple adverse effects must be considered. The data are too few to support the use of any particular betamimetics.
Crowley P. Prophylactic corticosteroids for preterm birth.
The Cochrane Database of Systematic Reviews 1996, Issue 1. Art. No.: CD000065. DOI: 10.1002/14651858.CD000065.
Authors' conclusions: Corticosteroids given prior to preterm birth (as a result of either preterm labour or elective preterm delivery) are effective in preventing respiratory distress syndrome and neonatal mortality. However there is not enough evidence to evaluate the use of repeated doses of corticosteroids in women who remain undelivered, but who are at continued risk of preterm birth.(This abstract has been prepared centrally.)
Crowther CA , Moore V. Magnesium maintenance therapy for preventing preterm birth after threatened preterm labour.
The Cochrane Database of Systematic Reviews 1998, Issue 1. Art. No.: CD000940. DOI: 10.1002/14651858.CD000940.
Authors' conclusions: There is not enough evidence to show any difference between magnesium maintenance therapy and either placebo or no treatment, or alternative therapies (ritodrine or terbutaline) in preventing preterm birth after an episode of threatened preterm labour.
Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened preterm labour.
The Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD001060. DOI: 10.1002/14651858.CD001060
Authors' conclusions: Magnesium sulphate is ineffective at delaying birth or preventing preterm birth, and its use is associated with an increased mortality for the infant. Any further trials should be of high quality, large enough to assess serious morbidity and mortality, compare different dose regimens, and provide neurodevelopmental status of the child.
Stan C, Boulvain M, Hirsbrunner-Amagbaly P, Pfister R. Hydration for treatment of preterm labour.
The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD003096. DOI: 10.1002/14651858.CD003096
Authors' conclusions: The data are too few to support the use of hydration as a specific treatment for women presenting with preterm labour. The two small studies available do not show any advantage of hydration compared to bed rest alone. Intravenous hydration does not seem to be beneficial, even during the period of evaluation soon after admission, in women with preterm labour. Women with evidence of dehydration may, however, benefit from the intervention.
Gaunekar NN, Crowther CA. Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour.
The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004071.pub2. DOI: 10.1002/14651858.CD004071.pub2.
Authors' conclusions: The role of maintenance therapy with calcium channel blockers for preventing preterm birth is not clear. Well designed randomised trials of sufficient size with relevant outcomes are required.
King JF, Flenady VJ, Papatsonis DNM, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour.
The Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002255. DOI: 10.1002/14651858.CD002255.
Authors' conclusions: When tocolysis is indicated for women in preterm labour, calcium channel blockers are preferable to other tocolytic agents compared, mainly betamimetics. Further research should address the effects of different dosage regimens and formulations of calcium channel blockers on maternal and neonatal outcomes.
King J, Flenady V. Prophylactic antibiotics for inhibiting preterm labour with intact membranes.
The Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD000246. DOI: 10.1002/14651858.CD000246.
Authors' conclusions: This review fails to demonstrate a clear overall benefit from prophylactic antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased neonatal mortality for those who received antibiotics. This treatment cannot therefore be currently recommended for routine practice. Further research may be justified (when sensitive markers for subclinical infection become available) in order to determine if there is a subgroup of women who could experience benefit from antibiotic treatment for preterm labour prior to membrane rupture, and to identify which antibiotic or combination of antibiotics is most effective.
Patient Education
Preterm Labor
March of Dimes: Fetal Fibronectin (fFN): A Test for Preterm Delivery
Preterm Premature Rupture of Membranes
Children's Hospital and Health System
University of Virginia Health System : Choose title from A – Z menu
