How to diagnose preterm labor: a clinical dilemma

Sonographic Methods of Evaluating Cervical Length: A Literature Review

Labor that begins between 20 and 37 weeks gestation is appropriately termed preterm labor. Some of the precipitating factors of preterm labor are changes in cervical status including dilatation and effacement. Until recently, a digital pelvic examination was considered the gold standard for evaluating cervical changes. Current research promotes the use of sonography for the prediction of preterm labor. It is essential for sonographers to become familiar with the various methods of cervical imaging including transabdominal, translabial, and transvaginal approaches. Each technique has its costs and benefits; however, a review of the current literature will show that the transvaginal method of cervical measurement is the most reliable.

Pseudolabor: A New Conversion Disorder Subtype? A Case Presentation and Literature Review

Pseudolabor is not a recognized conversion disorder subtype. The diagnosis of conversion disorder is suspected when a patient presents with symptoms under voluntary control that mimic a neurologic or medical condition. The term pseudolabor was first used in 1994 to describe a patient who presented at 27 weeks' gestation with monitored contraction activity and no palpable uterine contractions. A second case is presented herein. Both patients were initially managed as though they had preterm labor or uterine irritability with minimal cervical changes. The diagnosis was suspected only after each patient failed to respond to aggressive tocolysis. On external tocodynamometry, contractions were abrupt in onset and abrupt in descent. Only after palpating abdominal contractions and not uterine contractions did the attending physicians make the correct diagnosis. The development of pseudolabor in a patient with previously diagnosed pseudoseizures suggests that the condition was conversion disorder. The prevalence of pseudolabor is unknown and may be underestimated: electronic fetal monitoring has minimized the need to palpate uterine contractions in the laboring patient. The diagnosis of pseudolabor as a subtype of conversion disorder should be considered in any patient who presents with recurrent preterm uterine contractions, no (or minimal) cervical changes, and an atypical contraction pattern.

Pregnancy prolongation in women with preterm cervical dilatation utilizing out-patient preterm labor services

OBJECTIVE

To identify the impact of cervical dilatation on pregnancy prolongation in women with hospital evaluation of preterm labor (PTL) symptoms.

METHODS

The study population was identified from a database comprising women receiving out-patient perinatal services. Women diagnosed with PTL, having a singleton gestation, with cervical dilatation of > or =2 cm, intact membranes, and at 22.0-34.9 weeks when hospitalized for evaluation of PTL symptoms were included. Data were analyzed by cervical dilatation at hospital evaluation. The primary study outcome was gestational gain from PTL diagnosis.

RESULTS

A total of 1435 patients were analyzed; mean cervical dilatation at hospitalization was 2.6 +/- 0.7 cm at a mean of 32.4 +/- 2.1 weeks' gestation. Following hospitalization, patients gained a mean of 26.0 +/- 17.2 days. Eighty-seven per cent resumed out-patient services. Approximately 15% delivered within 1 week of PTL evaluation.

CONCLUSION

Even women with advanced cervical dilatation can achieve significant gestational gain. The degree of cervical dilatation has significant impact on latency to delivery in women evaluated for PTL.

Reducing the risk for preterm birth: evidence and implications for neonatal nurses

The incidence of preterm birth has been slowly rising despite advances in obstetric health care. Neonatal nurses have ongoing contact with women who have had a preterm birth and, thus, who are at high risk to have another preterm birth. This article discusses current evidence about reducing risk for preterm birth. Although preterm birth cannot always be prevented, preconception care can help identify and modify maternal risk and promote optimal health before conception. Quality prenatal care, as defined by the Institute of Medicine, consists of continuing risk assessment, health promotion, and interventions to modify medical and psychosocial risk. When these 3 components are consistently applied, they may confer some protection against preterm birth. Women at highest risk for preterm birth need to seek prenatal care from an expert in maternal-fetal medicine. Women also need to learn about the common, subtle signs of preterm labor so they can recognize symptoms and quickly seek treatment. Neonatal nurses can provide critical information and anticipatory guidance to women at risk for preterm birth so they can make sound decisions about future pregnancies.