Preterm birth (delivery between 20w0d to 36w6d) is the leading cause of neonatal mortality, affecting 12% of all deliveries, with 50% preceded by preterm labor. Preterm labor includes regular uterine contractions with cervical dilation, effacement or both. Preterm birth accounts for a significant burden of poor neonatal outcomes, including 70% of neonatal deaths, 36% of infant deaths, and up to 50% of long-term neurological impairment with a heavy financial burden. Of note, half of all patients hospitalized for preterm labor will deliver at term.
Tests to Stratify Risks of Preterm Birth
Note: Women with preterm contractions without cervical change generally should not be treated with tocolytics
Note: First line agents for tocolysis are beta-adrenergic agonists, calcium channel blockers or NSAIDs
Note: If magnesium sulfate is being used for neuroprotection, ACOG recommends that beta-adrenergic receptor agonists and calcium-channel blockers “should be used with caution in combination with magnesium sulfate for this indication” | <32 weeks, indomethacin is a potential option for tocolysis
Note: For more on antenatal steroids and the SMFM guidance on late preterm steroids, see ‘Related ObG Topics’ below
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