Preterm Labor: Prediction and Treatment (Obstetrics and Gynecology Clinics of North America, September 2005, Vol. 32, No. 3)

Preterm labor is the most common, catastrophic, and costly complication of pregnancy. It is responsible for the bulk of maternal antenatal hospital admissions and neonatal morbidity/mortality. This issue contains state-of-the-art information as it regards to standard methodology for diagnosing patients at risk for early delivery as well as a thorough explanation of all the advances in tocolytic treatment of women who go on to develop preterm labor. While it is exhaustively referenced and scientifically supported, this data will allow the practicing clinician to use these available techniques in a practical way to obtain the very best results for patients at risk for preterm delivery. Preterm Labor: Prediction and Treatment......Page 1 Uterine Contraction Assessment......Page 3 Normal uterine contractility......Page 4 Abnormal uterine contractility......Page 6 Potential interventions......Page 9 Clinical trials 1986 to 1989......Page 14 Clinical trials 1990 to 1993......Page 18 Clinical trials 1994 to 1997......Page 22 Meta-analysis of home uterine activity monitor......Page 24 Summary......Page 26 References......Page 27 Biochemical Markers for the Prediction of Preterm Labor......Page 30 Fetal fibronectin......Page 31 Estriol......Page 34 Corticotropin-releasing hormone......Page 36 beta-Human chorionic gonadotropin and alpha fetoprotein......Page 38 References......Page 39 Diagnosis of preterm labor and the limitations of manual cervical examination......Page 43 Technique of cervical sonography......Page 44 Evaluation of patients with suspected preterm labor......Page 46 When to measure transvaginal ultrasound cervical length in regards to contractions......Page 48 Management of preterm labor and cervical sonography......Page 49 Preterm labor, short cervical length, and infection......Page 50 The role of fetal fibronectin with cervical sonography in women with preterm labor......Page 51 What if the woman with preterm labor is bleeding?......Page 52 References......Page 54 Intrauterine infection and preterm birth......Page 57 Neonatal consequences of intrauterine infection......Page 58 Antibiotic treatment in patients with preterm labor......Page 59 Cervicitis......Page 62 Bacterial vaginosis......Page 63 Trichomoniasis......Page 64 Fetal fibronectin and intrauterine infection......Page 65 Distant infections and preterm birth......Page 66 References......Page 67 Why does preterm premature rupture of the membranes occur?......Page 71 What are the maternal risks associated with preterm premature rupture of the membranes?......Page 72 What are the fetal and neonatal risks of preterm premature rupture of the membranes?......Page 73 What evaluations should be considered for women with preterm premature rupture of the membranes?......Page 74 Where should conservative management be undertaken?......Page 75 How should the patient with preterm premature rupture of the membranes near term (32-36 weeks) be managed?......Page 76 How should the patient with premature rupture of the membranes remote from term (before 32 weeks' gestation) be managed?......Page 77 Can the patient with preterm premature rupture of the membranes be managed as an outpatient?......Page 78 What are the considerations regarding group B streptococcus prophylaxis after premature rupture of the membranes?......Page 79 What is the optimal antibiotic regimen during conservative management of premature rupture of the membranes remote from term?......Page 80 How should the patient with preterm premature rupture of the membranes and cerclage be managed?......Page 82 Should antenatal corticosteroids be given in the setting of preterm premature rupture of the membranes?......Page 83 Are neurologic complications linked to preterm premature rupture of the membranes?......Page 84 References......Page 85 Preterm Labor in Twins and High-Order Multiples......Page 89 Interventions to lower background contractions......Page 94 References......Page 97 Does Cerclage Prevent Preterm Birth?......Page 100 Classification......Page 101 Elective cerclage......Page 102 Should low-risk patients be screened?......Page 103 Urgent cerclage......Page 104 Other than cerclage, are there any other adjunctive treatments with antibiotics, tocolytics, or steroids that may benefit the patient?......Page 108 Emergent cerclage......Page 109 What is the best way to reduce the membranes above the cervix before cerclage placement?......Page 110 Should antibiotics or tocolytics be used?......Page 111 Transabdominal cerclage......Page 112 References......Page 113 beta-Agonist Tocolytic Therapy......Page 116 Food and Drug Administration......Page 117 Physiology......Page 118 Efficacy......Page 119 Maternal effects......Page 121 Therapeutic plan......Page 123 Subcutaneous pump therapy......Page 124 Efficacy......Page 127 Costs......Page 135 Summary......Page 138 References......Page 139 Magnesium Sulfate: The First-Line Tocolytic......Page 144 Pharmacology, dosage, and maternal complications......Page 145 Fetal and neonatal effects......Page 147 General clinical efficacy......Page 148 Magnesium sulfate versus placebo......Page 149 Magnesium sulfate versus prostaglandin synthetase inhibitors......Page 150 Magnesium sulfate versus beta-mimetics......Page 151 Combination tocolytic therapy......Page 152 Clinical efficacy......Page 153 Special clinical situations......Page 155 Summary......Page 156 References......Page 157 Antiprostaglandin drugs: mechanism of action......Page 160 Cyclooxygenase specificity......Page 162 Pharmacokinetics of indomethacin......Page 163 Indomethacin efficacy as a tocolytic......Page 164 Fetal and neonatal complications associated with indomethacin......Page 166 Cyxlooxygenase-2 inhibitors: rationale and use in preterm labor......Page 170 Cyxlooxygenase-2 inhibitors: safety......Page 171 Cyxlooxygenase-2 inhibitors: efficacy as a tocolytic......Page 172 References......Page 173 Use of Calcium Channel Antagonists for Preterm Labor......Page 177 Effectiveness......Page 178 Contraindications......Page 179 Dosing and administration......Page 180 References......Page 181 Preterm labor is the most common catastrophic complication of pregnancy. It is responsible for the bulk of maternal antenatal hospital admissions and neonatal morbidity/mortality. This book contains information on standard methodology for diagnosing patients at risk for early delivery and explains the advances in tocolytic treatment of women.