Preterm Labor. Management

Initial evaluation of patients with suspected preterm labor should include asssment of the presence and frequency of uterine contractions, the cervical status, and an assessment of gestational age. Before considering whether to use tocolysis, a search should be made for treatable factors of preterm labor, such as pyelonephritis, and an evaluation should be made to determine whether there are any maternal or fetal contraindications to a specific tocolytic treatment. Relative contraindications include mild hypertension, fetal growth restriction, and cervical dilatation greater than 4 cm. A urine culture is often obtained, and cultures of the lower genital tract for group B hemolytic streptococci, Chlamydia trachomatis, and Neisseria gonorrhoeae are recommended. Amniocentesis for fetal lung maturity and Gram stain as well as culture are frequently obtained, depending on the gestational age and the presenting clinical situation.
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