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Updated November 25, 2014.
Preterm labor is a complicated problem. While the causes are still unknown, there are several factors that may contribute to your risk for premature birth, including twin or more pregnancies, infection, cervical problems, maternal age, and smoking.
There are a few treatments that may prevent preterm labor in women at risk for premature birth, and some that may stop or slow labor if it begins early.
None of the treatments for premature labor are 100% effective, and not all laboring women are candidates for every treatment.
Preventing Preterm Labor in Women at Risk
Women at risk for preterm labor, particularly those who have had one or more premature births, may be candidates for one or more of the following treatments:- Progesterone: The medication progesterone has been used to prevent miscarriage and preterm birth for over 40 years. Although it has been used for a long time, studies disagree on whether or not progesterone actually works to prolong pregnancy in women who are at risk for premature birth.
- Cerclage: A cerclage is a stitch placed in the cervix to hold it closed. Cerclages have been used for over 50 years to prevent preterm birth. New research shows that cerclage does not stop labor once it has begun, but it can prolong pregnancy in some women.
- Bedrest: Although it is still used, especially in twin or higher pregnancies, bedrest alone is ineffective at preventing preterm birth. In fact, routine bedrest may actually increase the rate of preterm birth in some women.
- Antibiotics: Antibiotics may be given to women with preterm premature rupture of membranes (PPROM), a bag of water that has broken before the baby is due. Infection seems to be a risk factor for premature labor, and women with PPROM are at risk for uterine infection. Giving antibiotics can prolong pregnancy in women whose water breaks early.
Goals for Treating Preterm Labor
Happily, most women at risk for preterm labor will go on to deliver healthy, full term babies. But doctors are largely unable to prevent premature birth in women who are already showing signs of preterm labor. Even the most effective interventions usually only delay birth for a day or two.Because treatments for preterm labor only delay birth for a short time, the major goals of these treatments are to allow enough time to transfer a mom in premature labor to a hospital that has a NICU, and for steroids to be given to the mother. Steroids have been shown to speed up fetal lung development, making healthier preemies who require shorter NICU stays.
Medications to Treat Preterm Labor
Medication is the most common treatment for premature labor. Some medications, called tocolytics, affect the uterus directly to slow or stop contractions.- Magnesium sulfate:Magnesium sulfate is the most commonly used tocolytic. Magnesium sulfate has two extra benefits that make it the most commonly used tocolytic: It can prevent seizures in moms with preeclampsia, and it may help to reduce the incidence of cerebral palsy and other brain disorders in premature babies.
- Other tocolytics: Medications that affect the heart and lungs also affect the uterus, so doctors often use heart and lung medications to slow premature labor. Heart medications, such as nifedipine, and lung medications, such as terbutaline, are some of the more common medications used as tocolytics.
Sources:
Morgan, Maria PhD, Goldenberg, Robert MD and Schulkin, Jay PhD. "Obstetrician-Gynecologists' Screening and Management of Preterm Birth." Obstetrics and Gynecology July 2008; 112, 35-41.
Fox, Nathan MD and Chervenak, Frank MD. "Cervical Cerclage: A Review of the Evidence." Obstetrical and Gynecological Survey 2007; 63; 58-66.
Vidaeff, Alex and Ramin, Susan. "Management Strategies for the Prevention of Preterm Birth. Part I: Update on Progesterone Supplementation." Current Opinion in Obstetrics and Gynecology 2009; 21, 480-484.
Mercer, Brian MD and Merlino, Amy MD. "Magnesium Sulfate for Preterm Labor and Preterm Birth." Obstetrics and Gynecology September 2009; 114, 650-667.
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