From the Research
Interventions for preterm labor should prioritize the use of tocolytic medications, such as nifedipine and indomethacin, to temporarily delay delivery and allow time for corticosteroid administration and maternal transfer to appropriate facilities, as supported by the most recent and highest quality study 1.
Key Interventions
- Tocolytic medications:
- Nifedipine (10-20mg orally every 4-6 hours)
- Indomethacin (50-100mg loading dose followed by 25-50mg every 6 hours for up to 48 hours)
- Magnesium sulfate (4-6g IV loading dose followed by 1-4g/hour maintenance) for neuroprotection before 32 weeks
- Antenatal corticosteroids:
- Betamethasone (12mg IM, two doses 24 hours apart)
- Dexamethasone (6mg IM, four doses 12 hours apart) between 24-34 weeks to accelerate fetal lung maturity
- Preventive measures:
- Progesterone supplementation (200mg vaginal suppository daily or 250mg IM weekly) for women with prior spontaneous preterm birth or short cervix
- Cervical cerclage for women with cervical insufficiency
Important Considerations
- Management should be individualized based on gestational age, maternal and fetal conditions, and the specific cause of preterm labor 2, 1.
- Repeated courses of prenatal corticosteroids may improve neonatal outcomes compared to a single course, with decreased mortality and no long-term impairments 3.
- The use of antibiotics is indicated if group B streptococcus status is unknown or positive, or if there's evidence of infection.
- Bed rest and hydration have not been proven effective in preventing preterm labor.