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Progress in Preventing Preterm Labor

In the last few years, medical researchers have come up with several promising lines of research into the causes of preterm labor. In the process, they’ve discovered various means of predicting and maybe preventing the delivery of a premature baby. 

Progress in Preventing Preterm Labor

What is preterm labor? 

Preterm labor is defined by the American College of Obstetricians and Gynecology (ACOG) as uterine contractions and cervical changes (effacement) that occur before 37 weeks of pregnancy. Preterm birth occurs between 20- and 37 weeks gestation; a full-term pregnancy is about 40 weeks long. 

What is gestational age? 

Diagnosis and management of preterm labor are based on accurate, early documentation of gestational age.

Gestational age is determined in the fetus by menstrual history (last menstrual period) and ultrasound dating—this combination of factors provides the most accurate determination of gestational age. 

This determination is used to: 

  • Assess the intrauterine growth of the fetus
  • Make decisions about the timing of delivery in complicated pregnancies
  • Predict the newborn’s clinical course  

What are the signs and symptoms of premature labor?

Identifying the symptoms of preterm labor helps ensure the pregnant woman will be evaluated, diagnosed, and treated promptly. The signs and symptoms of preterm labor include: 

  • Constant low, dull backache 
  • A sensation of pelvic or lower abdominal pressure 
  • Mild abdominal cramps 
  • Light vaginal bleeding or spotting 
  • Preterm rupture of membranes —when the amniotic sac around the fetus breaks, there is a continuous flow or trickle of amniotic fluid from the vagina
  • A change in the consistency and color of the vaginal discharge–watery, mucoid, or bloody

Preterm labor isn’t always an indication you’ll have a preterm birth—but immediate medical attention is necessary.  

Preterm labor can happen during any pregnancy, but certain risk factors suggest a higher risk of preterm labor, including: 

  • preterm birth in a past pregnancy 
  • maternal age <18 or >40 
  • past gynecologic conditions or surgeries 
  • low body mass index 
  • lifestyle factors (smoking, drug use, stress, poor nutrition)

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How do healthcare providers test for premature labor? 

An obstetrics and gynecology doctor (ob/gyn) can perform the following tests to diagnose premature labor: 

Physical exam

Dr. Rad will perform a pelvic exam to determine the following: 

  • The membranes have ruptured
  • The cervix is getting thinner and beginning to stretch (efface)
  • The cervix is starting to open (dilation)

He will also evaluate the firmness and tenderness of the uterus, the size of the fetus, and its position. If there are abnormal findings, it could mean the patient is experiencing preterm labor. 

Transvaginal ultrasound 

Dr. Rad may perform a transvaginal ultrasound exam. A transvaginal ultrasound helps to distinguish cervical effacement due to active labor or cervical insufficiency (inability of the cervix to retain the fetus due to a structural or functional defect). 

Fetal fibronectin test (fFN test) 

Fetal fibronectin (fFN) is a protein that keeps the amniotic sac attached to the lining of the uterus. If this connection is disrupted, fetal fibronectin is released into the vaginal and cervical secretions. 

This connection can be disrupted by: 

  • infection 
  • inflammation 
  • the separation of the placenta from the wall of the uterus 
  • uterine contractions 
  • a short cervix 

A fetal fibronectin swab is a diagnostic test to predict preterm labor and premature rupture of fetal membranes. A cotton swab is used to swipe vaginal secretions near the cervix for testing. 

There are two possible test results

  • A positive fetal fibronectin test means fFN is present in cervical secretions. A positive fibronectin test in the second and third trimesters indicates an increased risk of premature birth within seven days. 
  • A negative fetal fibronectin test result means no fetal fibronectin was found in the secretions. In this case, the risk of going into preterm labor is less likely two weeks after the test is performed—though not for the remainder of the pregnancy. 

The fFN test is not meant for pregnant persons with placental abruption (premature detachment of the placenta). 

A fibronectin test in pregnancy is used for its negative predictive value—meaning if it’s negative, the pregnant person will unlikely deliver within the next seven days. 

Uterine monitoring 

Dr. Rad may use a uterine monitor to measure the duration and spacing of the contractions. If the monitor measures four or fewer contractions per hour, you’re not in labor.

He may suggest bed rest and drinking extra fluids because mild dehydration can induce contractions. 

Laboratory tests 

If a urine test results in a bladder, kidney, or urinary tract infection during preterm labor, Dr. Rad will prescribe antibiotics. Managing the infection can delay preterm labor.

Antibiotics also prevent infection in the amniotic fluid, membranes, or placenta. 

If a pregnant person has symptoms of preterm labor, immediately contact a healthcare provider or go to the hospital for evaluation.   

Can preterm labor be stopped or delayed?

Constant low, dull backache 

 Depending on the symptoms and the baby’s gestational age, Dr. Rad may prescribe medication or recommend a procedure to delay or stop a spontaneous preterm birth.

These options may include: 

Corticosteroids

Corticosteroids help enhance fetal development by promoting the maturation of the baby’s lungs. Dr. Rad recommends corticosteroids if there is a risk of delivery between 34 and 37 weeks. 

Magnesium sulfate 

If you are at risk of preterm birth and less than 32 weeks pregnant, Dr.Rad may provide magnesium sulfate. Research has shown it can reduce the risk of brain damage (cerebral palsy) for babies born before 32 weeks. 

Magnesium sulfate may cause minor side effects, including flushing, hot flashes, blurred vision, and weakness. 

Tocolytics 

Dr. Rad may prescribe a medication called a tocolytic to slow contractions temporarily. Tocolytics may be used for 48 hours to delay preterm labor, allowing corticosteroids to provide maximum benefit. 

Vaginal progesterone 

The American College of Obstetricians and Gynecologists (ACOG) recommends that patients with prior spontaneous preterm birth and singleton pregnancy be offered progesterone supplementation to prevent recurrent preterm birth —the Society endorses it for Maternal-Fetal Medicine. 

Progesterone therapy usually starts at 16-20 weeks gestation and continues until 36 weeks or until delivery. 

Cervical cerclage 

Cervical cerclage is a medical procedure that involves placing a stitch around the cervix to prevent cervical dilation. Cervical cerclage can be done as prophylaxis to prevent preterm delivery. The method is successful in almost 90% of cases.  

However, the timing of cervical cerclage can also affect the outcome. 

Preconception counseling and early prenatal care identify and treat risk conditions that optimize pregnancy outcomes. Dr. Rad advises expectant mothers to remain vigilant about their conditions.

Low-risk pregnancies can quickly escalate to fetal health emergencies and perinatal mortality. 

Dr. Rad’s expertise in managing high-risk pregnancies and maternal-fetal medicine places him at the forefront of accurately diagnosing and advising patients. 

Why choose Dr. Steve Rad and the Los Angeles Fetal and Maternal Care Center? 

Did you know that all pregnancies in the United States are at risk of becoming high-risk? That is no secret to double-board certified Dr. Steve Rad, an Obstetrician-Gynecologist with sub-specialty training in Maternal-Fetal Medicine / Perinatology. 

Dr. Rad has been named a top Maternal-Fetal Medicine specialist in Los Angeles by Los Angeles Magazine for six years. 

If you can’t see Dr. Rad in person, he also offers virtual consultations worldwide. 
 
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles.

We also offer in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.