Management of preterm labor

Hole and Tressler • Management of preterm labor P birth occurs in approximately 10% of pregnancies in the United States. Therefore, it is not only one of the most common obstetric complications, but also one of the most serious. After fetal anomalies, it is the leading cause of perinatal mortality, resulting in 70% of perinatal/neonatal losses. It is also one of the leading contributors to long-term morbidity, including mental retardation, developmental delay, cerebral palsy, seizure disorders, blindness, deafness, and nonneurologic disorders such as chronic pulmonary disease, and retinopathy of prematurity. This morbidity translates into a significant social problem, both for the families involved and for the cost in healthcare dollars, which has been estimated at greater than $2 billion annually.1 Preterm birth is indicated for medical or obstetric problems in 20% to 30% of total early deliveries, thus leaving 75% as spontaneous deliveries.2 Of these spontaneous deliveries, approximately two thirds are due to spontaneous labor, and one third due to premature rupture of the membranes. Romero and associates3 have used the term preterm labor syndrome for a model in which the fetal membranes and decidua respond to an inflammatory insult (infectious, ischemic, traumatic, or allergic) by producing cytokines and then bioactive lipids (including prostaglandins) that stimulate contractions and release proteases that damage the membranes and decidua with a final result of cervical ripening, dilation, and possible rupture. With a better understanding of the processes involved, obstetric care providers can determine which pregnancies are at risk for preterm labor and diagnose preterm labor in a timelier manner. Thus, preterm deliveries may become increasingly preventable.