Preterm Delivery Treatment

Preterm Delivery Treatment 

Background: It has been suggested that assessment of the frequency of uterine contractions could be used as a screening method to identify pregnant women who are at an increased risk of preterm delivery (before 35 weeks' of gestation) and also as a diagnostic test for detecting preterm labor in its earlier stages. However, the clinical value of this measurement is not clear. Ambulatory monitoring of uterine contractions continues to be used, even though several randomized trials have indicated that measurement of the frequency of contractions as a screening or diagnostic test has not been useful for reducing the rate of preterm delivery. The frequency of uterine contractions as a predictor of spontaneous preterm delivery was assessed in an observational study. Other variables that could affect the frequency of contractions such as the duration of gestation, the time of day, and the women's history with regard to preterm delivery were also considered. Other proposed markers of the risk of preterm delivery were also evaluated.

Methods: A total of 306 women were enrolled, all of whom had sigleton pregnancies between 22 and 24 weeks of gestation. The women monitored the frequency of their contractions twice daily on 2 or more days per week with a home contraction monitor to delivery or 37 weeks' gestation.

Results: A total of 34,908 hours of successful monitoring were obtained. More contractions were experienced by women who delivered before 35 weeks than by women who delivered at 35 weeks or later, but there was no identifiable threshold frequency that effectively identified women who delivered preterm infants. Other proposed screening tests, including digital and US evaluations of the cervix and assays for fetal fibronectin in cervicovaginal secretions, also demonstrated low sensitivity and positive predictive value for oreterm labor.

Conclusions: The likelihood of preterm delivery is increased with increasing frequency of uterine contractions. However, it does not appear that this measurement is clinically useful for the prediction of preterm delivery.