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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
8. Management
One quick and easy, but evidence-based and effective, triage maneuver that helps you differentiate true PTL from POOC is a single injection of subcutaneous terbutaline 0.25 mg. If the patient's contractions have significantly diminished or resolved in 2 hours after your intervention, this probably is not true PTL. By that time you may also have your ancillary studies back to help with the decision. While terbutaline has some downsides as a tocolytic (see below), its use here may be a clinically helpful maneuver.
Okay…., so now you've gotten your baseline studies, and you've decided this is real PTL and you want to try to formally stop the contractions. What does the evidence show are effective interventions? While often recommended, bed rest is not an evidence-based intervention
There are no randomized controlled trials (RCT) showing a benefit of bed rest in prolongation of pregnancy, and two studies in twins actually demonstrated an increase in preterm birth in the groups managed with bed rest. The medical downsides of bed rest include muscle weakness, osteoporosis, and thrombophlebitis . The social downsides include loss of employment, childcare problems, marital discord, and guilt when the regimen is not adhered to as recommended. Nevertheless, many women experience fewer contractions at rest, so individualize.
Hydration and sedation are also frequently employed strategies for this problem. Two RCT of hydration (1000 mL of intravenous Ringer's lactate) showed no benefit, nor did a trial employing morphine sulfate. The disadvantage of sedation is mainly fetal depression, while that of over-vigorous hydration may be pulmonary edema, especially when combined with aggressive tocolytic therapy.
