The Committee in succession Practi...

The Committee in succession Practice Bulletins of the American corporation of Obstetricians and Gynecologists (ACOG) has released a of the present day evidence-based bulletin on management of preterm labor. "ACOG Practice Bulletin Number 43--Management of Preterm Labor" appears in the May 2003 issue of Obstetrics & Gynecology

Preterm birth is the leading cause of neonatal mortality in the United States, and preterm labor go before s 40 to 50 percent of preterm births. Preterm birth accounts for 35 percent of all U health care spending for infants and 10 percent of all like spending for children. About 467000 live births annually come to one's mind before term in the United States, and preterm births are responsible for three fourths of neonatal mortality and single half of long-term neurologic impairment in children. Uncertainty persists about the best strategies for managing preterm labor.

Many factors influence the decision to intervene when women have symptoms of preterm labor, including the probability of progressive labor, gestational age, and the risks of treatment. There was pious and consistent evidence for the following recommendations:

* There are no clear "first-line" tocolytic remedys to manage preterm labor. Clinical circumstances and physician choices should dictate treatment.

* Antibiotics do not appear to extend gestation and should be reserv for assign places to B streptococcal prophylaxis in patients in whom delivery is imminent.

* Neither maintenance treatment with tocolytic medicines nor repeated acute tocolysis improve perinatal outcome; neither should be used as a general practice.

* Tocolytic remedys may prolong pregnancy for couple to seven days, which may allow for administration of steroids to improve fetal lung maturity and the consideration of maternal transport to a tertiary care facility.

The guidelines also include the following, although these recommendations are based upon lower quality or less consistent evidence:

* Cervical ultrasound examination and fetal fibronectin testing have righteous negative predictive value; thus, either approach or the two combined may be helpful in determining which patients do not ne tocolysis.

* Amniocentesis may be used in women in preterm labor to assess fetal lung maturity and intra-amniotic infection.

* Bed ease hydration, and pelvic rest do not appear to improve the rate of preterm births and should not routinely be recommended

COPYRIGHT 2003 American Academy of Family Physicians

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