Article Abstract:
Since preterm labor is a major cause of preterm delivery, efforts to prevent preterm birth are aimed at diagnosing preterm labor as early as possible so that effective management strategies can be initiated. Labor is generally defined as regular, intense contractions accompanied by progressive changes in the character of the cervix (dilation and thinning). Drugs that arrest labor, tocolytic agents, are more likely to fail if they are given after labor has progressed to its advanced stages, that is, when the cervix has become dilated more than two centimeters and is 80 percent effaced. In some cases, tocolysis is started in patients who have frequent contractions but who are not actually in labor. Since these medications are quite potent, accurate diagnosis is essential. When pregnancy is nearly completed (40 weeks of pregnancy is the normal term), the intensity of the uterine contractions can be used to differentiate true labor from false labor. However, when these contractions occur before the 37th week of pregnancy, a more sensitive method is necessary. Patient-perceived signs and symptoms of labor, such as contractions, discharge, pelvic pressure, backache and menstrual-like cramps, are unreliable and delay diagnosis. The rate of contractions can be measured using a home monitoring device (ambulatory tocodynamometer), which measures, records and transmits patterns of uterine contractions via the telephone to a perinatal nurse. This study included 51 women with a diagnosis of preterm labor verified by monitor tracings and physical exam. The women were divided into four groups on the basis of the reason for evaluation of preterm labor. Preterm labor was diagnosed by monitored uterine activity alone in 12 patients (24 percent), patient-perceived symptoms alone in 12 patients (24 percent), both contractions and symptoms in 22 patients (43 percent), or physical examination at a routine office visit detecting dilation of the cervix in five patients (nine percent). Fewer women in the monitored group delivered early. Therefore, relying on patient-perceived symptoms alone will delay a diagnosis of preterm labor in more than half of the patients. It is concluded that uterine activity is the most sensitive predictor of preterm labor and that women should report any symptoms of labor or uterine contractions, regardless of frequency. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Preterm birth, delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Preterm deliveries are more common in women carrying twins. Programs aimed at reducing the incidence of preterm delivery focus on identifying pregnancies at risk for early labor. A new home monitoring system measures, records and transmits patterns of uterine contractions via the telephone, which nursing specialists then assess for signs and symptoms of labor. The sooner preterm labor is detected, the more possible it is to arrest it with tocolytic drugs. The signs and symptoms of preterm labor include dilation of the cervix accompanied by regular uterine contractions. To see if home monitoring and daily nursing support helps detect preterm labor early, 45 women experiencing an initial episode of preterm labor while carrying twins were studied. Women were assigned to receive either home monitoring plus perinatal nursing support (19 patients) or a regular program of education regarding the signs and symptoms of labor (26 patients). Uterine patterns were transmitted to the perinatal nursing service twice a day, and nurses were available 24 hours a day. All the patients had a physical exam at least every two weeks. Preterm labor developed in 16 (62 percent) of the women who received the standard patient education protocol and 14 (74 percent) of the women in the home monitoring and nursing support program; this difference was not statistically significant, however. Cervical dilation was detected early (while it was less than three centimeters) in all of the monitored women experiencing preterm labor and in 10 of the women receiving the education protocol. The average dilation in the monitored group was 1.6 centimeters, compared with 2.9 centimeters in the education group (delivery occurs when the dilation of the cervix reaches about 10 centimeters). More of the patients receiving education alone delivered prematurely (81 percent) than women receiving home monitoring plus nursing support (50 percent). Home monitoring and nursing support was able to diagnose labor earlier and lower the preterm delivery rate by one third in women carrying twins. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Women carrying more than one fetus are at a particularly high risk for preterm labor. Some studies have shown that the onset of preterm labor is preceded by a marked increase in uterine contraction 24 to 72 hours before labor reaches its advanced stages. However, multiple pregnancies may have higher baseline contraction rate than women carrying only one fetus. To help clarify this issue, 39 twin gestations, 20 triplet gestations and 10 quadruplet pregnancies were studied. Each patient utilized a home monitoring system (ambulatory tocodynamometer), which measured, recorded and transmitted patterns of uterine contractions via the telephone to perinatal nurses trained to interpret the results. In addition, the nurses were available 24 hours a day to assess signs and symptoms of preterm labor. Uterine activity was found to increase slightly 48 hours before the onset of preterm labor and significantly beyond the levels established as baseline 24 hours before the onset of preterm labor. Since the monitoring was able to diagnose preterm labor before other signs of labor appeared (dilation and thinning of the cervix), the pregnancies were prolonged an additional 48 hours. Treatment with tocolytic agents, drugs that aim to arrest labor, had little or no effect on the crescendo of uterine contractions occurring before the onset of preterm labor. A crescendo of activity prior to preterm labor was seen in women carrying more than one fetus and was similar to that found in women with a single-fetus pregnancy. Home monitoring of uterine activity provided information that was useful in making an early preterm labor diagnosis in women carrying more than one fetus. (Consumer Summary produced by Reliance Medical Information, Inc.)
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