Authors' objectives:

This report addresses four main issues: 1.The appropriate criteria for diagnosing preterm labor, specifically with respect to the use of three biologic markers and their positive and negative predictive value. 2.The efficacy and effectiveness of tocolytics (pharmaceutical agents that arrest uterine contractions). 3.The efficacy and effectiveness of antibiotics (with respect to covert infections that might prompt preterm labor). 4.The efficacy of home uterine activity monitoring in decreasing adverse outcomes in women who are experiencing preterm labor.

Authors' recommendations: Based on the literature reviewed, two biologic markers (fetal fibronectin and endovaginal ultrasound) were found to be quite useful in identifying women in preterm labour who are at low risk of experiencing a preterm birth. Although the evidence remains mixed, certain tocolytes - beta-mimetics, calcium channel blockers, magnesium sulfate and NSAIDs - appear effective in prolonging pregnancy when used as first-line agents in arresting preterm labour, but beta-mimetics in comparison with other tocolytics seem to present a higher risk of maternal harms. Ethanol is not found to be an appropriate tocolytic agen. Tocolytics are not useful as maintenance interventions. Antibiotics for suspected genital tract infections may be useful. Home uterine activity monitoring was found to confer no maternal or fetal/neonatal benefits. The literature concerning the management of preterm labour is flawed in several ways relating largely to definitions of preterm labour, appropriate measures of outcomes, and use of survival analysis.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/pretermsum.htm

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)