Clinical Approach

Preterm labor is defined as cervical change in association with uterine contractions occurring between 20 and 37 weeks' gestation. The incidence in the United States is approximately 11% of pregnancies, and it is the cause of significant perinatal morbidity and mortality. Many risk factors are associated with preterm delivery (Table 32-1).

The main symptoms of preterm labor are uterine contractions and abdominal tightening. Sometimes, pelvic pressure or increased vaginal discharge also is present. The diagnosis is established by confirming cervical change over time by the same examiner, if possible, or finding the cervix to be 2 cm dilated and 80% effaced in a nulliparous woman. Once the diagnosis has been made, then an

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