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Premature Labor

Premature Labor - What To Expect

Last modified: 
23/04/2012 - 15:44

Contributing Author: Guy Slowik FRCS

After diagnosis of premature labor has been made, careful consideration must be given as to whether or not labor should be stopped. This will depend on a number of factors:

  • The mother's condition will be assessed by checking her vital signs and possibly doing blood tests.
  • The baby's status will be determined by monitoring the heartbeat and possibly by ultrasound analysis to estimate size and function of various organs.

Labor might be allowed to continue for the following reasons:

  • Most doctors will not try to stop labor if the mother is at 37 weeks gestation or beyond.
  • If the membranes are ruptured and the pregnancy has reached 34 weeks gestation, many obstetricians will be reluctant to try to stop labor.
  • If the mother or fetus demonstrates serious disease, this may be a reason not to attempt to stop labor.

If the decision is made to try to stop labor, several different methods can be used:

  • Depending on the condition of you and your baby, and how far labor has progressed (how much the cervix has effaced and dilated), intravenous tocolytic drug treatment for premature labor may be administered in the hospital.
  • Often, labor can be stopped in the hospital using intravenous medications, and then you can return home with instructions for reduced activity.

You will be instructed as to the safest activity level for your situation. This might be total bed rest in the hospital, complete bed rest at home with bathroom privileges, or partial bed rest - essentially, staying off your feet as much as possible.

You will also be instructed to keep yourself well hydrated.

Medications To Stop Contractions

When the decision has been made that premature labor should be stopped, a number of medications can be used in an effort to stop contractions and to assure the infant will be as mature as possible at birth.

Tocolytics

Tocolytics are medications that decrease uterine contractions. Tocolytic treatment is not uniformly successful and may cause serious side effects, so careful monitoring is necessary. Scientific studies show the ability of these drugs to prolong labor only by 48 hours.

  • The most commonly used tocolytic is magnesium sulfate, which is administered in the hospital through an intravenous drip.

Need To Know:

Women with known or suspected heart conditions should notify their physicians before administration of tocolytics.

Another group of tocolytics (ritodrine and terbutaline) can be used for preterm labor, but they can cause palpitations, fast heart rate, headaches and tremors.

Other drugs, such as prostaglandin blockers (Indometacin) and calcium channel blockers (nifedipine) are also used.

In-Utero Steroid Treatments

The most important and successful medications to treat preterm labor patients are glucocorticoid steroids (Betametasane and Decadron). These are given over a 24-hour time period by injection, and they increase the maturity and function of immature fetal lungs. These steroids have been proven to reduce premature neonate problems of respiratory diseases, ventilator use, and brain hemorrhage.

Steroid injections are best given within a certain gestational age range, usually 24 to 34 weeks. In the past, multiple injections were given, but recent research indicates that more than one injection may not be beneficial and may even be harmful to the baby.

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.