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History
A history of prior preterm deliveries places the patient in the high-risk category. Of
the predictors of preterm birth, past obstetric history may be one of the strongest
predictors of recurrent preterm birth.
Cervical length
A short cervical length in the early or late second trimester has been associated with
a markedly increased risk of preterm labor and delivery. In a study, a cervical length
of 25 mm or less at 28 weeks had a 49% sensitivity for prediction of preterm
delivery at less than 35 weeks. reference_ids_tool_tip reference_ids [1]
Laboratory tests
In patients with a history of midtrimester loss, laboratory tests for risk assessment
include the following:
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• Rapid plasma reagin test
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• Gonorrheal and chlamydial screening
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• Vaginal pH/wet smear/whiff test
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• Anticardiolipin antibody (eg, anticardiolipin immunoglobulin [Ig] G and IgM,
anti-beta2 microglobulin)
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• Lupus anticoagulant antibody
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• Activated partial thromboplastin time
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• One-hour glucose challenge test
Diagnosis
Contractions of sufficient frequency and intensity to effect progressive effacement
and dilation of the cervix at 24-37 weeks’ gestation are indicative of active preterm
labor. If the diagnosis of preterm labor is suspected, but not confirmed, it may be
prudent to first obtain a vaginal fetal fibronectin (FFN) sample before pelvic cervical
examination. If the diagnosis remains in doubt after the exam, the FFN specimen can
be sent to the lab for analysis.
Management
Progesterone
Tocolytic agents
The most common tocolytic agents used to treat preterm labor include the
following:
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• Magnesium sulfate (MgSO4): Widely used as the primary tocolytic agent
because it has similar efficacy to terbutaline (one of the previous agents of choice),
with far better tolerance
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• Indomethacin: An appropriate first-line tocolytic for early preterm labor (<
30 wk) or preterm labor associated with polyhydramnios
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• Nifedipine: Despite its unlabeled status, several randomized studies have
found nifedipine to be associated with a more frequent successful prolongation of
pregnancy than other tocolytics