Ep 164: Preterm Labor – What It Means and How to Manage It

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Preterm labor might not mean what you think it does. You’ll learn all about what it is (and isn’t) in this episode. This is the second in a three part series on preterm birth - you can go back and listen to the previous episode if you’d like to hear about some of the risk factors.

Now in today’s episode I’m not going to talk about what happens if you have a preterm birth, i.e. the outcomes for baby. Today is only about what happens when you experience preterm labor and how it is treated. Though preterm labor is one of the leading causes of preterm birth, it’s often treatable (50% of those who have preterm labor will not have a preterm birth) and you can go on and continue with your pregnancy relatively normally.

In this Episode, You’ll Learn About:

  • What are the signs and symptoms of preterm labor
  • When is it time to seek medical attention
  • How is preterm labor diagnosed
  • When is it better not to stop a preterm birth
  • What are the medications used to stop labor (called tocolytics)
  • What does recovery from preterm labor like
  • What interventions are not proven to work

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Keywords

birth, labor, medication, preterm birth, preterm labor, tocolytics

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Keywords

birth, labor, medication, preterm birth, preterm labor, tocolytics

Categories

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Ep 164: Preterm Labor – What It Means and How to Manage It

Nicole: In this episode, you are going to learn about preterm labor. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Nicole: Hello. Hello. Welcome to another episode of the podcast. This is episode number 164. As always, I'm so glad that you're spending some of your time with me today. So in this episode, you're going to learn about preterm labor, which is one of the leading causes of preterm birth. In last week's episode, episode 163, I went through risk factors for preterm birth. So you can go back and listen to that episode, if you haven't. Now, in this episode, we're gonna talk about preterm labor. You're gonna learn about the signs and symptoms of preterm labor, how we evaluate and diagnose preterm labor, the management for preterm labor, and then what to do after preterm labor stops. Now, one thing I am not going to talk about is what happens with your baby. If you have a preterm birth specifically like the outcomes for your baby, if you have a preterm birth, because that's pretty complicated in general, the earlier that your baby is born, the higher the chances of your baby having problems or being at risk for death. If your baby is preterm, I do have a great episode about things you wanna know if your baby's in the NICU, that is episode 76 of the podcast with Dr. Terry Major Kincaid. So do check that out if you have a preterm birth, but again, in this episode, I'm not going to go through all of the outcomes for babies who may be born early.

Nicole: Now, before we get into the episode, a quick listener, shout out. This is to NOLA movement. I love that NOLA movement. And the title of the review says, I'm ready. The review says so grateful for this podcast. As I look forward to pregnancy, I feel empowered in exploring what all of my options are. Thank you, Dr. Nicole. Well, you are so welcome NOLA movement. I am so glad that you feel empowered. When you think about pregnancy, another thing that can make folks feel empowered, make you feel empowered beyond this podcast, is my class on making a birth plan, making a birth plan, it's called Make A Birth Plan The Right Way. Those templates, forms and checklists that you find online, those are not enough to make a birth plan that actually works. In this one hour class, you will learn everything you need to know about making a birth plan: questions to ask, things to include, how to get folks to pay attention, because really a birth plan is so much more than that piece of paper. Really making a birth plan is a process where you understand that your doctor and your hospital are on your side for the things that you want for your birth and a piece of paper that you show up with when you're in labor, that's not gonna cut it.

Nicole: So check out the class. It's drnicolerankins.com/register. It's on demand. So you can take it when it's convenient for you. I will see you in the class. All right, let's talk about preterm labor. So the first thing that I want to say is that preterm labor does not automatically mean you are going to have a preterm birth. We have medicines that are fairly effective, and I'll go through the treatments later in at least delaying birth for 48 hours, even up to a week or so. But even if we don't give those medicines, those are called tocolytics to stop labor. Approximately 50% of women who are diagnosed with preterm labor will go on to give birth at term. So preterm labor does not always mean you will have a preterm birth. Now, with that being said, let's go ahead and talk about some of the symptoms of preterm labor.

Nicole: So it can be a little bit difficult to determine preterm labor. There are some signs and symptoms that may be present for several hours or days before preterm labor happens. Some of those things are menstrual like cramping, mild irregular contractions, an increase in pressure sensation in the vagina or in the pelvis. A low back ache can be present, some spotting or very light bleeding. Also vaginal discharge, like a mucus-y discharge. That can be clear. It can be slightly blood tinge. It can look like the mucus plug. Now, the thing about all of these things that is that they are pretty common symptoms. Like cramps can be pretty common, low back pain can be pretty common. So it's difficult to tell whether or not those symptoms are actually a sign of preterm labor. Diagnosing preterm labor is pretty imprecise, but when you have those symptoms, when you have those signs, you do wanna bring it up to your provider, especially if those things are persistent so that we can evaluate and check it out and make sure everything is okay.

Nicole: Now, if you had just sort of like mild symptoms, oh, I have a little bit of increase back ache, oh, I have a little bit of new discharge. Then you can typically be evaluated in the office. But if things are really intense and you're feeling like you're having contractions, then you're gonna wanna go to labor and delivery in order to be evaluated. So we can do a good thorough, comprehensive evaluation there. And the first thing that we're gonna start with when we're trying to decide if someone has preterm labor is really just talking to you, talking to you about what you're feeling, how often you've been feeling things, we're gonna going to want to know about your history during your pregnancy, your medical history, whether or not you have any risk factors for preterm birth, especially if you had a prior preterm birth. That is one of these strongest risk factors for having a preterm birth.

Nicole: We also want to look at things that can cause contractions, but may not actually be reflective of labor. For example, a placenta abruption can cause contractions, appendicitis can cause contractions because it's like irritating to the uterus. Um, a kidney infection can sometimes cause contractions, gall bladder infection can cause contractions. So we need to make sure that there are other things that aren't causing those contractions beside preterm labor. We also need to make sure we know exactly how far along you are during your pregnancy, because that's going to influence what we do in terms of the evaluation and treatment. And then of course, we put you on the monitor. See if you're having contractions, how frequently they are lasting, how long they are lasting, how intense they are. I always personally like to put my hands on someone's belly and feel the contractions that gives me an idea of how strong or how not strong they are.

Nicole: I always find that helpful. And I feel reassured when the contractions are not palpating as strong, we may do a speculum exam to look inside and see if we see any bleeding. Um, if you're complaining of a discharge, we may make sure that it's not your water that's broken. In some cases, we may do a wet prep examination to look for bacterial vaginosis. And then of course, we're going to check your cervix digitally, digitally. That means with our fingers and check and see if your cervix is dilated and that's opened, or if it's effaced. And then so if you are having regular contractions and your cervix is open when we check, then that is preterm labor. Now a lot of times people also ask about ultrasound and something that may help us is doing a transvaginal ultrasound to determine the length of your cervix, a cervix that is less than 30 millimeters.

Nicole: And that's three centimeters before 34 weeks is predictive of an increased risk of preterm birth. Where as a longer cervix, that's greater or equal to 30 millimeters, three centimeters. You are not at an increased risk for preterm birth. Now, the thing about transvaginal ultrasound is that it is not always available. You also have to be trained in order to do it the right way. So that is not something that I would say is necessarily commonly available. But in some places you will get a transvaginal ultrasound fairly quickly to try to determine if you are at risk for preterm labor, based on the length of your cervix. And then once we've established that you are in preterm labor, then typically we're gonna get an ultrasound to look for other things like where is the placenta? Are there any issues with the baby's growth? Is the fluid around the baby okay? What is the estimated baby's weight? Because that gives some good information for the NICU doctors and how they counsel you on what can happen with your preterm birth. So ultrasound isn't a huge part of that initial evaluation for preterm labor, but eventually it's going to come into play within the first, I would say 24 hours or so after we suspect that you have preterm labor, you will get an ultrasound.

Nicole: Now, as far as laboratory tests go, there is no great like laboratory test. That's going to say, Hey, we do this test. Yes, you're in preterm labor. No, you're not in preterm labor. Yes, you're at risk. No, you're not at risk. Something called a fetal fibronectin, which is a, uh, protein that is found in the, um, vagina. It's a protein that's thought to be part of the glue that holds the amniotic fluid or the amniotic sac rather. Um, next to the wall of the uterus. If we detect fetal fibronectin and it's detected by a little swab that's placed in your vagina. If we detect fetal fibronectin, that does indicate an increased risk of preterm birth within seven days. Um, but it's not certain that you're going to have a preterm birth just increases the risk. It is a good test. If it's negative, it's not likely that you're gonna have a preterm birth, but positive doesn't necessarily help predict it one way or another.

Nicole: So that is one laboratory test that we may do. Other laboratory tests that we'll do, we'll typically check a urine culture because pregnant folks can have asymptomatic bacteriuria, meaning bacteria in the urine that is asymptomatic, that does increase your risk of preterm birth. So we will check for that. And depending on your history, we may also check for sexually transmitted infections. Okay? So you come in, we put you on the monitor, we check your cervix, we check those tests. And then if it looks like you are having regular painful contractions and your cervix is opening, then that is preterm labor. If your cervix is not opening, then that is considered preterm contractions, not preterm labor. They're kind of sorta treated similarly, depending on how far along you are. But in general, preterm contractions are not as much of a concern. It's really preterm labor where your cervix is opening that we get concerned.

Nicole: Now, sometimes it may be the case that you come in, you're having contractions, we check and right away, we're like, oh, you're two centimeters or you're three centimeters. So then we know right away, yes, you are in preterm labor. But sometimes this is something that is decided over time. Like you may come in, you're having contractions and your cervix may be closed. We may have to say, Hey, we just have to watch you for a couple hours and see what things look like over time. So it's not necessarily a straightforward, easy, right away diagnosis that we can say, Hey, you are in preterm labor. Sometimes it takes a little bit of time to make that decision for sure. All right. Now once we have decided, okay, yes, you are having contractions. Your cervix is opening. You are in preterm labor. Then we need to talk about treatment and treatment can be a little bit tricky because it's really hard to identify who will actually go on to give birth preterm.

Nicole: Remember I said, even if we don't do anything about 50% of people will go on and still have a term birth. So it's kind of hard to identify who is actually going to go on and deliver. You are more likely to be in true labor if the intensity of your contractions increases. So if the contractions start at a lower level and they get to be more painful, more painful, more painful, then that is more likely to be true labor, uh, instead of, you know, um, just preterm contractions. So those are things that we look at, but again, it's not always easy to tell. So because of that, we generally, I don't wanna say like throw everything at it, but we treat everybody who has suspected preterm labor with all of the options and things that we have available because we want to do the best outcomes.

Nicole: So we're probably going to do all of the things. And then if things settle down, then great things settle down. Just bec-, and I'm saying this to say that just because if you go in with contractions, especially if you're early, you know, before 32 weeks, if you're early and we're like, Hey, we're gonna give you the steroids. Hey, we're gonna give you these medicines for the baby's brain. If we give you all of these things, it's not necessarily because we know or believe that you're certainly going to have your baby early. It's just that we don't know how to tell for sure. And we want to be sure that we give you all of the things just in case, because you can't go back and do the things you wanna provide. All of the options that are available so that the baby can, has the be, has the best chance of having a good outcome if it's born early.

Nicole: So I hope that makes sense. Okay. So with that being said, let's talk about treatment. I'm gonna break it down to greater than 34 weeks in before 34 weeks. So if you're greater than 34 weeks, then honestly we don't do a whole lot to tip the scales either way. Like we don't do anything to push you into labor, cuz that's still early, but we also don't do a whole lot to stop labor. Um, outcomes at 34 weeks for babies who are born at 34 weeks are very good. And especially if it's labor that happens naturally, like it's different than if it's labor that's induced because of say like preeclampsia for something at 34 weeks. Natural labor that happens at 34 weeks, babies tend to do well. Often the only thing we do is give steroids. Steroids and those are, um, specific steroids. They're beta methasone and dexamethasone.

Nicole: We only use those two, those two types of steroids because those are the only ones that cross the placenta and give benefit to the baby. So we may give steroids, they help mature the baby's lungs and prevent poor outcomes for babies that are born. Actually, we give steroids before anytime before 37 weeks, these days, but after 34 weeks, we give steroids and we may not do a whole lot more than that. If contractions settle down after a few hours and you're likely going to be able to go home. Okay, now if you're greater than, I'm sorry, if you're less than 34 weeks, then we're more likely to do all of the things. And let me tell you what all of the things are. Okay. So as I just mentioned, we're going to give you what's called antinatal corticosteroids and that's beta methasone or dexamethasone. And we know that they help reduce neonatal morbidity and mortality that's associated with preterm birth. This is one of the most important advances in preterm birth is steroids. They have made a huge, huge difference in order. Um, it,

Nicole: They have made a huge, huge difference in improving outcomes. For instance, back in the sixties, like a good example of this is, um, President Kennedy. They, uh, they had a baby that died who was around 33, 34 weeks, uh, and was, was preterm. They just didn't have all of the things in NICU that they have now to support babies. Like it would be unheard of for baby at 34 weeks to die today. And a lot of that is related to, uh, antinatal steroids. So you're definitely going to get steroids if less than 34 weeks in a preterm labor. You'll get antibiotics for GBS, antibiotic prophylaxis, GBS or group beta strep, is a bacteria that about 40% of pregnant folks carry. And it can cause babies to get pretty sick in rare circumstances. I talk about GBS in episode 31 of the podcast, but we wanna be sure that we prevent GBS from happening.

Nicole: So you're gonna get antibiotics for GBS. You will get magnesium sulfate through your IV. If you are less than 32 weeks, magnesium helps to provide what we call neuroprotection meaning it protects the baby's brain and it reduces the risk of cerebral palsy and other types of motor dysfunction in babies that are born preterm. We give that magnesium through your IV, anywhere from six to 12 hours, protocols are different at different hospitals. And then of course, the final thing that we do is something called tocolytics. Tocolytics are medications that stop labor. So Toko is contractions. Lytic is like stop. So stop labor. And we do tocolytic drugs typically for 48 hours. And we do it for 48 hours because that is how long, or that is the, the time that we know that the steroids have taken their maximum effect. So steroids have the most effect when mom has gotten them for 48 hours before birth. So we want to give those tocolytic drugs to stop contractions for at least 48 hours. Typically after the second dose of the stor steroid medication is done, um, or I should say 24 hours after the second dose of the steroid medication is done,

Nicole: Then we stop the tocolytics. And I guess I should back up and say, the steroids are given as a shot of medicine. Forgive me. This is one of those things where I know in my head what happens with beta methasone and dexamethasone, but you all don't. So let me explain it to you. So beta methasone is an injection it's given in your arm and then you give the second one 24 hours after the first one and then 24 hours after that. The second one is when we would stop the tocolytic drugs. Dexamethasone is given slightly different. It's given every 12 hours for a total of four doses, and then we stop it, um, 24 hours after the, the last dose. So that is how we give tocolytics and tocolytics are great for delaying birth for 48 hours, even decent for delaying birth for seven days, but they're not that great for delaying birth to, um, 37 weeks so to full term. So they help really in the short term for getting the steroid medications on board, they also help in the short term for being able to transfer someone to a higher level of facility of care. If the baby is really, really preterm. So generally we do those tocolytic medications for 48 hours, and then we stop them. There's one instance where sometimes people continue them and I'll talk about that. It's not evidence based, but I'll talk about that in a second.

Nicole: Now I said that less than 34 weeks, we go kind of full court press in terms of everything that we do in order to prevent preterm birth when someone has preterm labor, but there is a lower limit where before that we don't do anything to stop labor because we don't have any, um, interventions that can help. Okay? So the lowest that we can go is 22 weeks. And at 22 weeks, we have equipment where a small baby can be intubated. And even that is not 100%, but we can at least try. When I say we, I mean the NICU doctors can try at 22 weeks, but that is not typical that babies are going to survive and do well at 22 weeks. But 22 weeks has kind of, um, been the new standard or, um, gestational age where we can consider resuscitating babies. And I'm hesitating because it really is hospital dependent.

Nicole: Um, some hospitals don't do interventions that early some hospitals are at 23 weeks, but in general, 22 to 23 weeks is where we have things that we can intervene in order to support a baby that's born early. Now there's some instances where we should not give tocolytics, where we should not try and stop labor. It's actually contraindicated. If there is a intrauterine fetal death, then we should not stop labor. If the baby has a lethal anomaly, then we should not stop labor. If the heart rate tracing is not reassuring, and we're worried that the baby is in distress, then we should not stop labor, uh, preeclampsia with severe features or eclampsia, which is seizures on top of preeclampsia, we should not stop labor. If mom is bleeding and is not stable, we should not stop labor. If there is an entry amniotic infection also called chorioamnionitis, that's an infection of the membranes and the placenta. Then we should not stop labor because the cure for that is to deliver the baby.

Nicole: Okay. So what are the medications that we use in order to stop labor? These are called tocolytics and the most effective ones are endomethacin. That is a cyclooxygenase inhibitor. And that works really well. Actually, it's one of the first line treatments for stopping labor, but there are some side effects, maternal side effects. It can cause nausea. It can cause reflux. It can cause gastritis. It can cause vomiting. Uh, those side effects aren't common, but they can happen. There are more severe potential baby side effects or fetal side effects. So there are two big concerns. One is something called constriction of the ductus arteriosis. The ductus arteriosis is a vascular structure in the heart. And if it's closed too early, it can lead to something called pulmonary hypertension or also tricuspid regurgitation. Those are both heart issues. So you have to be careful with how long you do the endomethacin exposure

Nicole: You also have to be mindful of the gestational age. If you're going to give endomethacin, it is not recommended after 32 weeks, because the increased risk of premature closure of the ductus arteriosis is after 32 weeks in particular. The other issue that can be caused with endomethacin is it can cause the fluid oligos, the fluid around the baby to be low. And that is thought to be because of the effect on the kidneys, it reduces the baby's urine output and then will in turn decrease the amniotic fluid volume. This is seen most often if you take it for greater than 72 hours. So we typically really only do it for 48 hours at the most 72 hours for endomethacin, but it does work well to stop contractions. Another medicine that is commonly used is something called nifedipine. Nifedipine is a calcium channel blocker.

Nicole: It is also a blood pressure medicine. The way that it works is it's, what's called a peripheral vasodilator. And because of that envasodilator means it just opens blood vessels. And because of that, it may cause symptoms in mom like nausea, flushing, headaches, dizziness, even palpitations. Some of that may be re related to reducing your blood pressure. But fortunately has very few side effects on baby. So not many side effects, um, from the baby on nifedipine. There are very few contraindications to calcium channel blockers or nifedipine. Really the biggest one is that if you already have low blood pressure, because this is a blood pressure medicine, then sometimes we can't use it. If you already have blood pressure, that's pretty low. Also you have to be careful with using nifedipine, a calcium channel blocker and magnesium, because it's sort of a complicated, theoretical risk that if you get too much magnesium in your system, the way to fix too, me too much magnesium in your system is to give calcium.

Nicole: I'm not gonna explain like the physics or physiology of how that works rather, but if you have too much magnesium, you give calcium, but if you're giving what's called a calcium channel blocker, then that's not gonna work. If you give the calcium, if you have too much magnesium. So that risk is theoretical, that that interaction can occur. But that medicine also works pretty well for stopping contractions too. Another one that is used more. So for kind of short term relief of contractions is Turbutaline, it comes in oral forms. It also comes in injectable forms. We typically only use Turbutaline to short term start contractions. It used to be used on a more, um, long term basis. However, the FDA warned that it really shouldn't be used for more than 48 to 72 hours because there's an increased risk of heart problems and death.

Nicole: So Turbutaline is rarely used for more than just a short term course of stopping contractions, but it is fairly effective. Now, what is less effective is magnesium sulfate, magnesium sulfate I mentioned earlier can be used to, or should be used to help prevent, um, or help protect the brain. It's a neuroprotective agent, but it's also an agent that can stop contractions. It's been studied for a long time for over 40 years. However, it's just not that great at stopping contractions. It's it's not as effective as the nifedipine or the endomethecin. So this is really more of a second line agent. It also kind of makes you feel just, eh, when you're on magnesium, doesn't have to, but for most people it does, it can cause sweating. It can cause flushing, uh, and just make, makes you just not necessarily feel great. Fortunately, there are very few side effects to baby. It may cause the fetal heart rate tracing to look a little bit flatter than it otherwise would, but it doesn't have any long term effects on baby. It is contraindicated in patients who have myasthenia gravis. And if you have myasthenia gravis, it's a muscular disorder and you have to be careful because magne magnesium is eliminated by the kidneys. So if you have issues with your kidney function, then we have to be careful about how we administer the magnesium so that we don't give you too much.

Nicole: So that's really it for the medicines that we know that can stop labor endomethacin, nifedipine, magnesium and the terbutaline for short term. What is not effective is bed rest. Bed rest doesn't help. Hydration doesn't help. Hydration is good for stopping contractions. If they're caused by dehydration. If you get dehydrated, there's a chemical get that gets released. That can cause you to have contractions, but they're not labor contractions. So we hydrate not because it stops labor, but because it stops dehydration contractions, and again, bedrest is not effective can also be harmful. It increases the risk of blood clots, deconditioning, osteoporosis. So we do not recommend strict bedrest as a method of reducing or stopping preterm labor.

Nicole: Okay. So what happens, we, if we give you the 48 hours of the tocolytic medicine, the contraction stop. So then what happens going forward? Well, if you are greater than 34 weeks and contractions stop, then typically you're gonna be able to go home fairly quickly. You don't have to stay in the hospital for prolonged periods of time. That may be adjusted depending on how far away you live from the hospital and those kinds of things. But typically if you're greater than 34 weeks, you don't have a lot of restrictions or things you can can't do. And you're able to go home fairly quickly. If you have threatened preterm labor, if you're less than 34 weeks, then how long you stay in the hospital is really on a case by case basis. It depends on how far along you are. If you have threatened preterm labor at 24 weeks, then we're definitely gonna keep you in the hospital for a bit longer, but to make sure things are okay before you go home.

Nicole: It also depends on how dilated your cervix, is your past obstetric history. So if you had a prior preterm birth, then we probably are gonna keep you in the hospital longer. Another important factor is how far away you live from the hospital. So if you live a long distance away, then we may recommend that you stay in the hospital at minimum, you are going to be in the hospital until you complete the steroids until you're off of the tocolytic medication. So you can expect that if you have threatened preterm labor, and we do all the things you're gonna be in the hospital at minimum two days, that is like the bare bare minimum. And typically it it's gonna be longer. Um, I would say three to five days, even, even longer, if you're, if you're earlier or if you're, uh, pretty dilated, as far as resuming your activities.

Nicole: After an episode of threatened preterm labor, most people can resume their activities of daily living. You definitely don't have to be on bed rest. We do suggest that you don't lift anything greater than 20 pounds. We also don't want you doing like strenuous exercise exercises and that's not because they're strong evidence that exercise or lifting causes problems. It's really just that any of the studies that look at preterm labor always exclude or don't have people do exercise. It's a hard thing to study to say, Hey, you're a cervix is three centimeters dilated. Let's have you run around a lot and do exercise and see what happens. You know, nobody's gonna do that. So in general we say limit strenuous activity. Are gentle walks, gonna be okay. Yes. Gentle yoga. Yes. It's really that strenuous exercise that we worry about work is always something that is evaluated on a case by case basis.

Nicole: Um, typically you can return to work and it's gonna depend if you're super dilated, then probably not. But if you're just a mildly dilated one or two centimeters, three centimeters, then if you are not working more than 40 hours a week, if you're not standing a lot and by standing, that's more than eight hours in a day or more than four consecutive hours at a time, if you're not doing heavy physical work, then you can probably go back to work. If you're just sitting at a desk, um, or you can go back to work and have reduced activity. Again, this is another thing that is very difficult to assess, um, and study. But, and it's also difficult because when people are out of work and they don't have income, that can be a real challenge. So it's a case by case basis. There's no strong evidence that you have to be outta work, but you're probably going to have to limit your activity to some degree.

Nicole: And then a final couple other things, um, travel. It's unlikely that travel increases the risk of preterm labor or preterm birth. But in general, we tell folks, you know, don't travel too far. You don't wanna be too far from your usual doctor and hospital. Um, you don't wanna be far away from a hospital. So just really talk to your doctor if you're planning some sort of travel. And then the final thing is sexual intercourse. We typically say, you know, avoid sexual intercourse. If you know that afterwards, it can cause you to have contractions, which some people do, there isn't strong evidence that it affects your risk of preterm birth. Um, it is theoretically possible that it can, I would think, especially if you are more dilated and just having the membranes exposed and things like that. So you can play it on a case by case basis. And by sexual intercourse, let me say, I specifically mean penile to vaginal intercourse as a, a thing that can cause, um, issues. There are other forms of intimacy that are, that are just fine.

Nicole: Now, some things that are not effective after we have stopped preterm labor or have, or after preterm labor has stopped, is maintenance tocolysis meaning staying on a medication that stops contractions. There's no evidence that this works, but some people do use nifedipine or prescribe folks nifedipine to take at home as a maintenance tocolysis, there's no evidence that it works. Um, but some people do do it. It really depends on your physician. It can be effective if you're having annoying preterm contractions that aren't really causing your cervix to dilate nifedipine at home three times a day can be helpful, but again, it's not really evidence based. Um, back in the day, people used to be on magnesium for weeks. People used to be on Turbutaline for weeks. We don't do those things anymore. Nifedipine is the only one that may be prescribed in terms of trying to keep contractions, um, away after that first 48 hours. But it's not based on much evidence.

Nicole: We also don't do repeated fe fetal fibronectin testing. Remember fetal fibronectin is that vaginal swab that I said can predict preterm birth within the first seven days or so, or indicate an increased risk. We don't repeat that again. Also home uterine activity monitoring doesn't help. And by that, I mean, like having a monitor at home that can see your contractions, that doesn't help, um, either in terms of reducing the risk of preterm labor going on to be preterm birth. All right. So that is it just to recap, preterm labor does not equal preterm birth. 50% of folks who have preterm labor go on to deliver full term. The definition of preterm labor is regular contractions and cervical change. You have to have both to be in labor. That's the same definition for term labor. If you're greater than 34 weeks, we don't do a lot to stop labor.

Nicole: If you are in between 22 weeks and 34 weeks, then we're gonna do all of the things because we don't know who's gonna go into labor or who's not. And all of those treatments include antinatal corticosteroids, betamethasone or dexamethasone, and then tocolytics that's endomethacin, nifedipine, magnesium or tributaline. We also do magnesium for neuroprotection to protect the brain if it's less than 32 weeks. And then once labor stops, then how long you stay in the hospital or your need to reduce work will vary. One thing that is constant is that bed rest is not helpful. Okay. So there you have it. Do me a solid share this podcast with a friend. If you find it useful, that helps me to reach and serve more people. Also subscribe to the podcast, in Apple Podcast or wherever you're listening to me right now. And I'd love it. If you leave a review in Apple Podcast, I do shout outs from those reviews. And I just love to hear what you say about this show. Do come follow me over on Instagram. Uh, that's where I provide more information about pregnancy and birth and quotes and all kinds of good, great stuff. So follow me on Instagram @drnicolerankins. Okay. So that's it for this episode, do come one back next week and remember that you deserve a beautiful pregnancy and birth.

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