A List of Options Once Premature Labor Has Begun

Understanding the early signs and treatment options

USA, Utah, Payson, Man assisting childbirth in hospital
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Premature (preterm) labor can be one of the most distressing situations a woman can face and one for which most couples are unprepared. While the exact cause of a premature birth may be unknown, there are factors that can increase risk, including multiple pregnancy, certain infections, cervical problems, older maternal age, and smoking.

There are today several treatments that may help prevent preterm labor in women at high risk as well as others the can slow contractions if labor begins prematurely.

On the downside, some of these treatments are less effective in certain women and entirely contradicted in others.

Symptoms of Preterm Labor

Preterm labor occurs in approximately 12 percent of all pregnancies. In some cases, it may be possible to prevent premature birth by knowing the early signs. Some of the most telling symptoms include:

  • Five or more contractions within an hour
  • Watery fluid from the vagina (indicating your water may have broken)
  • A dull backache below the waist that may come and go or be constant
  • Menstrual-like cramps in the lower abdomen
  • Pelvic pressure that feels like your baby is pushing down

Preventing Preterm Labor in At-Risk Women

Women at risk for preterm labor, particularly those who have had one or more premature births, may be candidates for one or more of the following treatments:

  • Progesterone has been used to prevent miscarriage and preterm birth for over 40 years. Despite its widespread use, studies conflict on whether progesterone can actually prolong pregnancy in women at risk of premature delivery.
  • Cerclage is a stitch placed in the cervix to hold it closed. While cerclages have been used for over 50 years to prevent preterm birth, research suggests that it can only prolong pregnancy (and only in some women) and will not stop labor once it has begun
  • Bed rest is typically advised for women experiencing multiple pregnancy, eclampsia, preeclampsia, heavy vaginal bleeding, abnormal cervical changes, fetal development, placental complications, or gestational diabetes.
  • Antibiotics are usually prescribed to women who experience the preterm rupture of membranes to prevent uterine infections which can lead to preterm birth. Antibiotics can also prolong pregnancy in women who have previously experienced a preterm rupture.

Treating Preterm Labor

Realistically speaking, it is often difficult to turn things around once a woman shows the signs of preterm labor. Even the most effective interventions usually only delay birth for a day or two.

Because of this, the two major goals of treatment are to allow enough time to transfer a mother to a hospital which has a neonatal intensive care unit (NICU) and to provides steroids to speed up fetal lung development.

There is a number of medications doctor will turn to during a premature labor. Some, called tocolytics, are specifically designed to slow or stop uterine contractions.

Among the most commonly prescribed is magnesium sulfate which has a two-fold effect: to prevent seizures in women with preeclampsia and to reduce the risk of cerebral palsy and other brain disorders in premature babies.

Other tocolytics include drugs used to treat heart and lung problems, such as nifedipine and terbutaline, both of which are effective in inhibiting uterine contractions.

Sources

  • Morgan, M.; Goldenberg, R.; and Schulkin, J. "Obstetrician-Gynecologists' Screening and Management of Preterm Birth." Obstetrics and Gynecology. 2008; 112:35-41.
  • Vidaeff, A. and Ramin, S. "Management Strategies for the Prevention of Preterm Birth. Part I: Update on Progesterone Supplementation." Current Opinion in Obstetrics and Gynecology. 2009; 21:480-484.

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