Modern management of premature labor

Abstract

Objective: Preterm labor is the leading cause of perinatal mortality and morbidity in the developed world. The purpose of this report is to analyze the current knowledge to prevent the preterm delivery and its practical management.

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Methods: Report is based on literature, and on research reports from Finland.

Results: In Finland, the births before 37 completed weeks account for 5.4% of all births, and babies with a birth weight below 2500 g 4.4% and below 1500g about 1.0% of all newborns. The main predictive factors of preterm birth are multiple pregnancy, previous preterm birth, and second trimester bleeding. Clinically, the most promising methods for prediction may be vaginal ultrasound and presence of fibronectin in cervical secretions. Home monitoring of uterine contractions may not be worthwhile. Cervico-vaginal infection may play substantial role in the development of pre-term labor with or without pre-labor rupture of membranes. The role of antibiotics in the management is intensively researched. Tocolysis has been attempted with ethanol, beta-agonists, magnesium, prostaglandin synthetase inhibitors, calcium channel blockers, glyceryl trinitrate, oxytocin antagonist, and inhibitors of inducible form of cyclooxygenase. So far, no real progress has been achieved in the prevention of preterm delivery. Instead, remarkable advances have been achieved in the care of very low birth weight and low birth weight babies.

Conclusion: Therefore, the main goals are: to postpone the delivery in order to transfer the mother to a center with neonatal intensive care unit, to gain time for corticosteroid treatment, and to minimize the neonatal consequences of preterm labor.