II. Management: Initial

  1. Evaluation and Labs as described for Preterm Labor
  2. Treat genitourinary infections if present
  3. Bedrest
  4. Consider Intravenous Fluid for dehydration
    1. Administer IV 1-2 liters of Lactated Ringers
  5. Treat underlying causes
    1. Urinary Tract Infection
  6. Group B Streptococcus Prophylaxis
    1. Start antibiotics if positive culture for GBS or status unknown this pregnancy
    2. If status unkown, obtain rectovaginal culture and may stop antibiotics if negative
  7. Notify primary doctor regarding possible delivery
  8. Labor precautions
    1. Limit maternal Narcotics for pain control
    2. Anticipate malpresentations
    3. Complete cervical dilation may be less than 10 cm
    4. Elective ceserean <36 weeks offered in some settings
  9. Consider transport to tertiary center with NICU
    1. Strongly consider if <34 weeks gestation
    2. Contraindications
      1. Imminent delivery
      2. Fetal Distress or maternal status unstable
      3. No safe transport to referral center

III. Management: Corticosteroids

  1. Indications
    1. Intact membranes at 24-34 weeks
    2. PPROM without Chorioamnionitis at 24 to 32 weeks
  2. Mechanism
    1. Promotes Fetal Lung Maturity
  3. Preparations
    1. Betamethasone 12 mg IM q24 hours for 2 doses
    2. Dexamethasone 6mg IM q12 hours for 4 doses
  4. Course
    1. Delay delivery at least 24-48 hours after steroids
      1. See Tocolytics below
    2. No longer recommended to repeat weekly
      1. Administer only first week
      2. Lee (2004) Obstet Gynecol 103:274-81 [PubMed]

IV. Management: Tocolytic agents

  1. See Tocolytic

V. Management: Ambulatory Protocol

  1. Weekly cervical exam between 20 and 37 weeks
  2. Home self monitoring for contractions
    1. Evaluation for over 4 to 6 contractions per hour
  3. Pelvic rest
  4. Bedrest
  5. Patient Education regarding Preterm Labor
  6. Oral Tocolytics are not effective
    1. Avoid oral Terbutaline and Nifedipine
    2. Also avoid Indomethacin due to adverse effects

VI. References

  1. Iams in Gabbe (2002) Obstetrics p.755
  2. Huddleston (2003) Clin Perinatol 30:803-24 [PubMed]

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