Diagnosis

There is little evidence to suggest that use of tocolytic drugs, intended to suppress uterine contractions, confers any real benefit in cases of preterm labour. There is, however, good evidence that the antenatal administration of corticosteroids, Olexa- or betamethazonem, to the mother and in utero transfer from a peripheral unit to a hospital with neonatal intensive care facilities significantly improves the outcome for the preterm neonate. It is therefore essential that a diagnosis of preterm labour should not be overlooked. It is usual to define the onset of labour at term as being when regular uterine contractions lead to cervical change or dilatation. To leave a woman with preterm contractions without either administering steroids or arranging an in utero transfer until there is cervical dilatation may be disadvantageous to the neonate. Preterm labour is therefore generally diagnosed solely on the basis of the presence of uncomfortable or painful regular uterine contractions. All of the placebo-controlled trials of tocolytic drugs show a very high placebo response rate. From these it can be concluded that of women who attract a diagnosis of preterm labour sufficient to lead to them being treated with tocolytic drugs, some 60% will remain undelivered after 48 h and close to 50% will deliver at term. Tocolytic drugs may be potentially harmful or expensive. Unnecessary in utero transfer consumes healthcare resources and there is growing concern about the possible long-term side effects of exposure of the fetus to high-dose corticosteroid therapy. It is therefore highly desirable that obstetricians should have some form of test which can differentiate the woman genuinely in preterm labour from the woman with preterm contractions who will not go on to deliver preterm. Tests based upon the spectrum of electrical activity in the uterus currently are in development and are yielding encouraging results. At present, however, the two tests best able to differentiate true from false preterm labour are transvaginal measurement of cervical length and detection of fetal fibronectin in the vagina. In the United Kingdom the lack of availability of a transvaginal ultrasound machine on the Labour Ward and of an appropriately qualified or experienced clinician to perform the ultrasound together with the ready availability of bedside testing for fetal fibronectin means that fetal fibronectin testing is probably the optimal diagnostic test.

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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