From the Research
Bed rest and hydration are not effective interventions for preventing preterm labor, and instead, evidence-based practices such as progesterone supplementation, cervical cerclage, and tocolytic medications should be considered. Effective interventions for preventing preterm labor include both medical treatments and lifestyle modifications. For women with a history of spontaneous preterm birth or a short cervix, progesterone supplementation is recommended, typically as vaginal progesterone 200mg daily or intramuscular 17-alpha-hydroxyprogesterone caproate (17P) 250mg weekly from 16-36 weeks 1. Cervical cerclage may be beneficial for women with a short cervix (<25mm) and history of preterm birth. For acute preterm labor, tocolytic medications can temporarily delay delivery to allow for corticosteroid administration. Common tocolytics include nifedipine (10-20mg orally every 4-6 hours), indomethacin (50mg loading dose followed by 25mg every 6 hours for up to 48 hours), or magnesium sulfate (4-6g IV loading dose followed by 1-2g/hour) 2. Corticosteroids (betamethasone 12mg IM, two doses 24 hours apart, or dexamethasone 6mg IM, four doses 12 hours apart) should be given to accelerate fetal lung maturity when preterm birth appears imminent between 24-34 weeks. Lifestyle modifications include smoking cessation, avoiding substance use, maintaining appropriate nutrition, managing chronic conditions, and reducing physical and psychological stress. These interventions work by addressing various pathways that trigger preterm labor, including inflammation, cervical insufficiency, and uterine contractions. Some key points to consider when managing preterm labor include:
- The ultimate goal of treating preterm labor is to prolong the pregnancy long enough to decrease the incidence of neonatal mortality and morbidity associated with prematurity, while minimizing maternal and fetal risks 3
- Preterm birth is the leading cause of neonatal mortality and a substantial portion of all birth-related short- and long-term morbidity 4
- Most efforts to prevent preterm labor have not proven to be effective, and equally frustrating, most efforts at arresting preterm labor once started have failed 4
- Delivery in a medical center with an experienced resuscitation team and the availability of a newborn intensive care unit will ensure the best possible neonatal outcomes 4