When 'Labor Day' Comes Early
The Pharmaceutical Approach
If a women comes in with uterine contractions before 34 weeks,
doctors typically assess the cervix to document contractions and/or other
changes to the cervix.
"For practical purposes, the cut-off most people use is 34
weeks for treating preterm labor," Chasen says. Between 34 and 37 weeks,
complications of prematurity are rare, so doctors don't necessarily employ
aggressive treatment, he says.
"The most important thing is to give steroids to accelerate
the maturity of the baby should he or she be born," he says. "Giving
steroids can decrease lung complications or brain complication and decrease
A type of medications called tocolytic agents may be used to
stop the whole labor process and let the pregnancy progress. They include
terbutaline, which relaxes the uterus and decreases contractions, but this drug
has not been officially approved for preterm labor. Another drug, ritodrine,
was pulled from the market when the FDA required further testing and the
company declined to bear the cost of further studies.
Magnesium sulfate may also be used to disrupt the communication
that allows muscles to contract. It is usually given through an intravenous
infusion into the arm. The heart drug Procardia may also be used to decrease
contractions by blocking the muscle's communication system.
"These medications can delay delivery long enough for
steroids to have beneficial effects," Chasen says. Another drug, Antocin,
is in the FDA pipeline.
The Home-Monitoring Approach
Sometimes women at high risk of preterm labor will choose home
uterine monitoring, which is basically a belt they strap on twice a day for an
hour each time. While the pregnant woman is wearing the belt, she will push a
button on it every time she thinks she feels a contraction. The information is
then transmitted to her doctor.
The emergence of these home-monitoring devices rubs many
professionals the wrong way.
"The bottom line is that no one has demonstrated that it
leads to healthier pregnancies or delivery at a later gestational age,"
Lam, however, says they're a fine way to keep tabs on things
and to alert the woman if she needs medical attention.