Prevention of Preterm Birth

Jeffrey M. Denney; Jennifer F. Culhane; Robert L. Goldenberg

Disclosures

Women's Health. 2008;4(6):625-638. 

In This Article

Early Identification of Preterm Labor

On the premise that labor-inhibiting drugs are effective only if administered before preterm labor has been fully established, a number of strategies have evolved to identify women in early preterm labor. Typically, pregnant women receive instruction in detecting contractions or other signs of labor, such as pelvic pressure, vaginal discharge and back pain.[90] The March of Dimes prematurity-prevention program, which included instruction in uterine self-palpation and detection of signs of labor, did not reduce preterm births when tested prospectively in five different settings.[91] Another method of detecting uterine contractions before the onset of active preterm labor is home uterine activity monitoring, in which a contraction monitor records data on uterine activity and transfers the information to a central site for analysis.[92,93,94,95] The monitor was approved by the US FDA primarily because it can detect contractions, the data can be transmitted to a central location and contractions are associated with an increased risk of preterm birth. However, in most randomized trials, this approach has failed to prevent preterm births. One study of home uterine-activity monitoring demonstrated that this intervention not only failed to reduce preterm births, but its use was also associated with an increased number of unscheduled hospital visits and increased use of tocolytic drugs.[95] Strategies using home uterine-activity monitoring have often included daily contact with a nurse, and several authors have suggested that this interaction may result in a reduced rate of preterm birth. These data are, at best, conflicting and there is little evidence that daily contact with a nurse, as compared with routine prenatal care, reduces preterm births.[96]

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