From the Research
The management of a pregnant woman experiencing premature contractions should focus on stopping labor and prolonging pregnancy when appropriate, with first-line medications including nifedipine or atosiban for 48 hours, as they have been shown to have similar perinatal outcomes and safety profiles 1. The initial assessment includes evaluating gestational age, maternal and fetal status, and ruling out conditions requiring immediate delivery.
- Evaluating gestational age is crucial to determine the best course of action, as it affects the decision to administer antenatal corticosteroids and the type of tocolytic agent used.
- Maternal and fetal status should be closely monitored to identify any potential complications that may arise during the management of premature contractions.
- Ruling out conditions requiring immediate delivery, such as placental abruption or fetal distress, is essential to ensure the best possible outcome for both the mother and the fetus.
For acute tocolysis,
- nifedipine (10-20mg orally every 4-6 hours) or atosiban can be used as first-line medications, as they have been shown to be effective in delaying delivery and improving perinatal outcomes 1.
- Indomethacin (50mg loading dose followed by 25mg every 6 hours for up to 48 hours, before 32 weeks) or magnesium sulfate (4-6g IV loading dose followed by 1-4g/hour maintenance) may also be considered, although their use may be limited by potential side effects and contraindications.
- Betamimetics like terbutaline (0.25mg subcutaneously every 3-4 hours) are less commonly used due to cardiovascular side effects, and their use should be carefully considered on a case-by-case basis.
If preterm labor is diagnosed between 24-34 weeks,
- antenatal corticosteroids (betamethasone 12mg IM, two doses 24 hours apart, or dexamethasone 6mg IM, four doses 12 hours apart) should be administered to accelerate fetal lung maturity, as they have been shown to reduce the incidence and severity of respiratory distress syndrome 2, 3.
- Magnesium sulfate may be given for fetal neuroprotection if delivery appears imminent before 32 weeks, as it has been shown to reduce the risk of cerebral palsy and other neurodevelopmental disorders 4, 5.
Antibiotics are indicated if Group B Streptococcus status is positive or unknown,
- as they can help reduce the risk of neonatal sepsis and other complications associated with Group B Streptococcus infection 4, 3.
- Bed rest, hydration, and continuous fetal monitoring are supportive measures that can help manage premature contractions and reduce the risk of complications.
The underlying cause of premature contractions should be identified and addressed when possible,