About Preterm Labor and Child Birth
Some of the approaches have included regular cervical exams in pregnancy (to detect early changes in the cervix), teaching women how to recognize uterine contractions, electronic monitoring for uterine contractions, and evaluation of a variety of naturally occurring chemical substances in the vagina or maternal blood stream. Since the signs and symptoms of preterm labor frequently overlap the normal symptoms of pregnancy, most prevention programs are not very effective.
A new test ...
Recent reports of a biochemical substance detectable in the vagina have shown some promise. Fetal Fibronectin is a special protein which has been identified in vaginal secretions in the early weeks of pregnancy, and again 1-2 weeks before labor begins. Studies have shown that the test for fetal fibronectin (a simple swab of vaginal fluid) is helpful in predicting preterm delivery, and the test may help predict the opposite problem - pregnancies which continue postterm. The test seems to be most helpful in predicting which of the women with a diagnosis of preterm labor (contractions plus change in the cervix) will actually deliver early, since up to 50% may continue to term with no treatment. Fetal fibronectin may also be helpful in predicting preterm labor in women who have no symptoms.
How is preterm labor treated?
How to treat preterm labor (or whether to treat at all) remains a question yet to be answered. Bedrest and intravenous fluids are believed to help stop contractions for some women, but clear benefit has not been shown. Treating preterm labor with medication has historically been unpleasant for the mother, at times dangerous, and has shown limited benefit in reducing numbers of preterm births.
Studies have not shown a clear improvement in the survival of preterm babies or how well they do later with long term use of drugs to stop contractions of the uterus (tocolytics). Side effects are very common and dangerous effects, though quite rare (fluid in the lungs, blood chemistry imbalances, heart problems, liver and kidney complications and even death) have been recorded.
Today, tocolytic drugs appear most helpful in delaying birth for a few days to a week. This time may allow transfer of the mother to a high risk center with capability to care for the preterm infant or the use of steroid drugs to speed up maturing of the baby's lungs. Babies between 24 and 34 weeks gestation clearly benefit when steroids are given to the mother before delivery. These infants
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