Diagnosis And Treatment Of Preterm Labor

The methods for the diagnosis and treatment of preterm labor are based on an inadequate literature that is compromised not only by the oft-cited paucity of well-designed and adequately powered clinical trials but also, even more, by an incomplete understanding of the sequence and timing of events that precede clinical evidence of preterm labor, such as progressive cervical dilatation and ruptured membranes. Because the progression from subclinical preterm parturition to overt preterm labor is often gradual, standard criteria for the diagnosis of preterm labor (uterine contractions accompanied by cervical change) lack precision. Consequently, preterm labor is often overdiagnosed so that women with frequent contractions who are not in labor are enrolled in studies of tocolytic drugs (King et al., 1988). Women treated to prevent or arrest preterm labor may therefore have been treated successfully or may not have required treatment at all. The true result of treatment is known with confidence only for those whose treatment was unsuccessful.

Useful studies of methods for the prevention or arrest of preterm labor therefore depend on the development of more accurate methods for the diagnosis of preterm labor. The current uncertainty is reflected by the division of clinicians into two camps: those who believe that nothing works and others who claim great success with various interventions. The truth likely falls somewhere in between but will emerge only if additional resources are devoted to improving the means of diagnosis of preterm labor.

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