Preterm Labor -- Treatment

If you are experiencing any of the signs and symptoms of preterm contractions, you should notify your health care provider at once. Preterm contractions can often be stopped with a combination of medication, rest and hydration. The goal is to stop preterm contractions before they can affect a change in the cervix, becoming preterm labor. Once you are actually in preterm labor, the goal is to again, either stop the contractions or delay delivery until you can be relocated to a hospital with the appropriate neonatal intensive care unit support to give your baby the greatest chance to positive neonatal course.

Once you have called your health care provider for possible preterm contractions, there are several options of what you may be instructed to do. These will most likely be dependent upon your gestation, the length of your pregnancy, and your own risk factors.

Your health care provider may ask that you stop what you are doing and rest, often on your left side. While you are resting, you may also be asked to drink 2-3 glasses of water or juice (no caffeine or soda products) to make sure you are hydrated. If your contractions continue, your health care provider may want to evaluate you in the office or the hospital.

TESTS AND EVALUATIONS

Some of the testing done to evaluate possible preterm labor are:

• electronic fetal monitoring -- this will display your contractions along the graph paper along with the pattern of the baby's heart rate, showing how well the baby is tolerating the contractions
• ultrasonography -- an ultrasound can be used to measure the length of the cervix to tell if it has shortened in response to the contractions
• cervical exam -- your health care provider will most likely perform a vaginal exam to see if any cervcial dilation or effacement has occurred as a result of the contractions. If so, you would then be considered to have preterm labor as opposed to preterm contractions.
• fetal fibronectin -- this test measures the amount of fetal fibronectin, a protein that helps predict the risk of preterm labor. This test can be preformed between 24 and 34 weeks of pregnancy. If the fetal fibronectin test is negative, the chances are small that you would deliver within two weeks.

TREATMENTS

HYDRATION

The simplest of treatments for preterm contractions/labor is hydration. Often you will be given an IV to maintain adequate hydration.

MEDICATIONS

The first form of medications for preterm labor/contractions are called tocolytics. These are given expressly to minimize or stop contractions. Different tocolytics have different modes of action and different side effects. Some can cause you to feel jittery and anxious, some can cause you to feel weak and lethargic, some seem to have no effect at all. Some are given by mouth, some by injection and some intravenously. It may be necessary for you to have one or multiple tocolytics. Often health care providers will start with one form and if that is not successful, then attempt another medication.

Another form of medication you may be given are corticosteriods. These are not given for you, they are given for your baby. Corticosteriods cross the placenta barrier and helps the baby's lungs to mature by escalating the production of the surfactant phosphatidylglycerol. This increases the baby's chance to live if born prematurely. These steriods are not the type you have heard about which cause "steroid rage". You will most likely be given two injections, either twelve or twenty four hours apart.

Occasionally your health care provider may order other medications as an adjunct to tocolytics and corticosteriods. If you have any signs and symptoms of urinary tract infections, you may be treated with antibiotics. Some health care providers order sedation to help the mother be more comfortable from the side effects of various tocolytics.

Once your contractions have subsided and you begin to be discharged from the hospital, you may be placed on oral tocolytics until you reach 35 weeks of pregnancy. You may be instructed to remain on bedrest, although there is much debate among health care providers regarding the effectiveness of bedrest in arresting preterm contractions. You will most likely begin to have more frequent visits with your health care provider. You may go home with a home monitoring company where you will monitor your contractions at home periodically and transmit the results via a phone line to an independent company which reports to your health care provider.

One thing is for certain, once you have had a bout of preterm contractions or preterm labor, the rest of your pregnancy is different. You are not likely to be contraction free for the rest of the pregnancy and you will find yourself much more attentive to what is going on in your body and with your baby.

Next we will look at what happens if preterm labor can't be stopped.