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 mortality."
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," Chasen says.
Lam, however, says they're a fine way to keep tabs on things and to alert the woman if she needs medical attention.