When 'Labor Day' Comes Early
The Pharmaceutical Approach continued...
"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.
"You use a thermometer to take someone's temperature to see
if they have a fever, and if they do, you have to treat them because the
thermometer won't cure the fever," he says. "The same is true with home
uterine monitoring. It's a diagnostic tool, not a therapeutic tool."
Janet Bleyl is an advocate of home uterine activity monitoring.
"We have thousands of women who have known early on they're having preterm
labor because of home monitoring," says Bleyl, founder and president of the
Triplet Connection, a Stockton, Calif.-based nonprofit group for families who
have had or who are expecting triplets or more.
"We have seen lots of patients in preterm labor who, due to
drugs and aggressive treatment, have prolonged their pregnancy from weeks to
months," she tells WebMD.
Because of the insidious nature of premature labor, "women
who find themselves in it are unable to detect it themselves, which is why home
monitoring can be so important and useful," she says.