Management of pregnant women after inhibition of acute preterm labor
- Steve Caritis, MD
Steve Caritis, MD
- Professor of Obstetrics, Gynecology, and Reproductive Sciences
- University of Pittsburgh School of Medicine
- Hyagriv N Simhan, MD, MS
Hyagriv N Simhan, MD, MS
- Professor & Chief, Division of Maternal-Fetal Medicine
- Executive Vice Chair, Obstetrical Services Department of Ob/Gyn/RS
- University of Pittsburgh School of Medicine
- Medical Director of Obstetrical Services
- Magee-Womens Hospital of UPMC
The optimal management of pregnancies after resolution of an acute episode of preterm labor (PTL) is unknown. No large randomized trials have compared various management strategies.
This topic will review management of women who do not have advanced cervical dilation after treatment of acute idiopathic PTL. The evaluation and management of women with suspected PTL are discussed separately. (See "Diagnosis of preterm labor and overview of preterm birth" and "Inhibition of acute preterm labor".)
Is hospitalization beneficial? — The value of prolonged hospitalization for stable women after treatment of an episode of suspected PTL has not been studied. We consider women with advanced cervical dilation, vaginal bleeding, nonreassuring fetal status, or a long travel time to a hospital with appropriate levels of obstetric and neonatal care services examples of obstetrically unstable patients in whom ongoing in-hospital observation may be useful, but we make this decision on a case-by-case basis, depending on patient-specific factors. These situations are associated with an increased probability of birth away from a tertiary care center and a birth that may incur significant morbidity for the mother and/or newborn.
The only randomized trial designed to determine whether hospitalization of women with arrested PTL increased the proportion of deliveries ≥36 weeks compared with women discharged home did not find a benefit . In this trial, 101 women with singleton gestations, intact membranes, mean cervical dilation of 2.7 cm, and a diagnosis of arrested PTL between 240/7 and 334/7 weeks of gestation were randomly assigned to hospitalization until 34 weeks or discharged home upon completion of a course of dexamethasone. Tocolytics were not given; contractions ceased with conservative management alone. In both groups, about 70 percent of women delivered at ≥36 weeks of gestation. This trial was underpowered and is not generalizable to the more clinically relevant population of women with arrested PTL after tocolytic therapy .
Is bed rest beneficial? — There is no evidence supporting bed rest as an effective intervention for prevention of spontaneous preterm birth in singletons [3,4] or twins . Bed rest has known potential harms: It promotes loss of trabecular bone density, increases venous thromboembolism risk, produces musculoskeletal deconditioning, and places significant psychosocial strain on individuals and families [3,6-12]. Based on lack of evidence of efficacy in prematurity prevention, and known significant risks, we do not recommend bed rest for women with a recent history of PTL.
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- PHYSICAL ACTIVITY
- Is hospitalization beneficial?
- Is bed rest beneficial?
- Should exercise and work be avoided?
- Should sexual activity be avoided?
- Should travel be avoided?
- TESTS AND DEVICES NOT USEFUL FOR PATIENT MONITORING
- Fetal fibronectin testing
- Home uterine activity monitoring
- MEDICATION MANAGEMENT
- Progesterone supplementation
- Antenatal corticosteroids
- Maintenance tocolysis
- Antibiotic prophylaxis
- - Group B streptococcus (GBS)
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS