Premature labor, Part II: Management.

BACKGROUND As the second paper in a two-part series on preterm labor, this article discusses the management of preterm labor as it relates to risk reduction, tocolytic therapy, corticosteroids, and antibiotics. METHODS Published literature on the management of preterm labor was reviewed by searching MEDLINE files from 1983 to the present, using the terms "preterm labor," "premature labor," "preterm labor and antibiotics," "tocolytic agents," "tocolysis," "betamethasone," and "premature rupture of membranes." Additional references were obtained by cross-referencing bibliographies from available articles. RESULTS AND CONCLUSIONS Effective management of preterm labor and birth begins with an assessment and reduction of risks for all pregnant women. In addition, pregnant women should be screened and appropriately treated for urologic and gynecologic infections (e.g., syphilis, gonorrhea, Chlamydia, and bacterial vaginosis). Women who are at high risk for preterm birth should be enrolled in a preterm birth prevention program that includes frequent contact with health professionals, patient education about the signs and symptoms of preterm labor, home monitoring, and regular cervical examinations. For women who develop preterm labor that does not require immediate delivery, recommended management strategies include reduced activity, early tocolytic therapy, corticosteroids for up to 34 weeks' gestation (both for women with intact and ruptured membranes), and antibiotics for known infections. Early studies also suggest that prophylactic antibiotics can be beneficial for women with idiopathic preterm labor or preterm premature rupture of membranes.