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. Cover......Page 1 Preface......Page 2 Uterine Contraction Assessment......Page 4 Normal uterine contractility......Page 5 Abnormal uterine contractility......Page 7 Potential interventions......Page 10 Clinical trials 1986 to 1989......Page 15 Clinical trials 1990 to 1993......Page 19 Clinical trials 1994 to 1997......Page 23 Meta-analysis of home uterine activity monitor......Page 25 Summary......Page 27 References......Page 28 Biochemical Markers for the Prediction of Preterm Labor......Page 31 Fetal fibronectin......Page 32 Estriol......Page 35 Corticotropin-releasing hormone......Page 37 beta-Human chorionic gonadotropin and alpha fetoprotein......Page 39 References......Page 40 Diagnosis of preterm labor and the limitations of manual cervical examination......Page 44 Technique of cervical sonography......Page 45 Evaluation of patients with suspected preterm labor......Page 47 When to measure transvaginal ultrasound cervical length in regards to contractions......Page 49 Management of preterm labor and cervical sonography......Page 50 Preterm labor, short cervical length, and infection......Page 51 The role of fetal fibronectin with cervical sonography in women with preterm labor......Page 52 What if the woman with preterm labor is bleeding?......Page 53 References......Page 55 Intrauterine infection and preterm birth......Page 58 Neonatal consequences of intrauterine infection......Page 59 Antibiotic treatment in patients with preterm labor......Page 60 Cervicitis......Page 63 Bacterial vaginosis......Page 64 Trichomoniasis......Page 65 Fetal fibronectin and intrauterine infection......Page 66 Distant infections and preterm birth......Page 67 References......Page 68 Why does preterm premature rupture of the membranes occur?......Page 72 What are the maternal risks associated with preterm premature rupture of the membranes?......Page 73 What are the fetal and neonatal risks of preterm premature rupture of the membranes?......Page 74 What evaluations should be considered for women with preterm premature rupture of the membranes?......Page 75 Where should conservative management be undertaken?......Page 76 How should the patient with preterm premature rupture of the membranes near term (32-36 weeks) be managed?......Page 77 How should the patient with premature rupture of the membranes remote from term (before 32 weeks' gestation) be managed?......Page 78 Can the patient with preterm premature rupture of the membranes be managed as an outpatient?......Page 79 What are the considerations regarding group B streptococcus prophylaxis after premature rupture of the membranes?......Page 80 What is the optimal antibiotic regimen during conservative management of premature rupture of the membranes remote from term?......Page 81 How should the patient with preterm premature rupture of the membranes and cerclage be managed?......Page 83 Should antenatal corticosteroids be given in the setting of preterm premature rupture of the membranes?......Page 84 Are neurologic complications linked to preterm premature rupture of the membranes?......Page 85 References......Page 86 Preterm Labor in Twins and High-Order Multiples......Page 90 Interventions to lower background contractions......Page 95 References......Page 98 Does Cerclage Prevent Preterm Birth?......Page 101 Classification......Page 102 Elective cerclage......Page 103 Should low-risk patients be screened?......Page 104 Urgent cerclage......Page 105 Other than cerclage, are there any other adjunctive treatments with antibiotics, tocolytics, or steroids that may benefit the patient?......Page 109 Emergent cerclage......Page 110 What is the best way to reduce the membranes above the cervix before cerclage placement?......Page 111 Should antibiotics or tocolytics be used?......Page 112 Transabdominal cerclage......Page 113 References......Page 114 beta-Agonist Tocolytic Therapy......Page 117 Food and Drug Administration......Page 118 Physiology......Page 119 Efficacy......Page 120 Maternal effects......Page 122 Therapeutic plan......Page 124 Subcutaneous pump therapy......Page 125 Efficacy......Page 128 Costs......Page 136 Summary......Page 139 References......Page 140 Magnesium Sulfate: The First-Line Tocolytic......Page 145 Pharmacology, dosage, and maternal complications......Page 146 Fetal and neonatal effects......Page 148 General clinical efficacy......Page 149 Magnesium sulfate versus placebo......Page 150 Magnesium sulfate versus prostaglandin synthetase inhibitors......Page 151 Magnesium sulfate versus beta-mimetics......Page 152 Combination tocolytic therapy......Page 153 Clinical efficacy......Page 154 Special clinical situations......Page 156 Summary......Page 157 References......Page 158 Antiprostaglandin drugs: mechanism of action......Page 161 Cyclooxygenase specificity......Page 163 Pharmacokinetics of indomethacin......Page 164 Indomethacin efficacy as a tocolytic......Page 165 Fetal and neonatal complications associated with indomethacin......Page 167 Cyxlooxygenase-2 inhibitors: rationale and use in preterm labor......Page 171 Cyxlooxygenase-2 inhibitors: safety......Page 172 Cyxlooxygenase-2 inhibitors: efficacy as a tocolytic......Page 173 References......Page 174 Use of Calcium Channel Antagonists for Preterm Labor......Page 178 Effectiveness......Page 179 Contraindications......Page 180 Dosing and administration......Page 181 References......Page 182 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.