{"id":344252,"date":"2014-11-19T01:00:00","date_gmt":"2014-11-19T00:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/when-the-birth-begins-too-early\/"},"modified":"2023-01-18T22:49:08","modified_gmt":"2023-01-18T21:49:08","slug":"when-the-birth-begins-too-early","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/when-the-birth-begins-too-early\/","title":{"rendered":"When the birth begins too early"},"content":{"rendered":"<p><strong>Preterm labor is an indication of impending preterm birth. Various measures are possible to prevent premature birth, including tocolysis. In practice, it is useful to identify risk factors for preterm birth as early as possible and to counteract them if possible. This includes the treatment of infectious diseases and good adjustment of diseases of the pregnant woman (hypertension, diabetes, etc.).<\/strong><\/p>\n<p> <!--more--> <\/p>\n<p>Clinical assessment of preterm labor remains difficult. We rely on the following criteria &#8211; knowing that sensitivity and specificity are not proven:<\/p>\n<ul>\n<li>Regular contractions,<\/li>\n<li>Painful contractions,<\/li>\n<li>\u2265 four contractions per 20 minutes.<\/li>\n<\/ul>\n<p>The clear evidence of labor is the progress of the birth. However, this evidence usually cannot be waited for, because if you wait for cervix-opening labor, you may miss the timely start of therapy for labor inhibition. Threatened preterm birth between the 20th and the end of the 36th week of pregnancy is defined as follows:<\/p>\n<ul>\n<li>\u2265Four contractions per 20 minutes and sonographic cervical length &lt;20 mm.<\/li>\n<li>\u2265Four contractions per 20 minutes and sonographic cervical length between 20 and 29 mm, but with positive fibronectin test.<\/li>\n<\/ul>\n<h2 id=\"primary-prevention\">Primary prevention<\/h2>\n<p>It is important to identify increased risk for preterm birth as early as possible. The risk of preterm labor is influenced by various factors <strong>(Tab. 1)<\/strong>. One of them is the interval after a birth until the next conception: this should be at least 18 months, less than six months is unfavorable. The ideal maternal age is between 20 and 35 years. When using artificial reproductive technology (ART), multiples should be avoided whenever possible. Other preventive measures include a normal BMI, stopping smoking, &#8220;treating&#8221; poverty (nutrition, hygiene, etc.), treating sexually transmitted diseases before pregnancy, and abstaining from illegal drugs such as cocaine.<\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\" size-full wp-image-4853\" alt=\"\" src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11.png\" style=\"height:635px; width:600px\" width=\"855\" height=\"905\" srcset=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11.png 855w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11-800x847.png 800w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11-120x127.png 120w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11-90x95.png 90w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11-320x339.png 320w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab1_hp11-560x593.png 560w\" sizes=\"(max-width: 855px) 100vw, 855px\" \/><\/p>\n<p>Supplementation of 800 mg\/d docosahexaenoic acid (DHA) reduced preterm birth in non-risk women in several randomized trials. Administration of magnesium per os also showed indirect beneficial effects. Data on probiotics are still insufficient. Vaginal application of progesterone appears to reduce infant morbidity and also mortality. Currently, progesterone is used for two indications of singleton pregnancy: status post preterm delivery and cervical shortening (measured sonographically) in the current pregnancy.<\/p>\n<h2 id=\"secondary-prevention\">Secondary prevention<\/h2>\n<p>For secondary prevention, smoking cessation is recommended. In addition, the pregnant woman should not perform physically rigorous work (night shift). Physical rest to some extent is useful, but the disadvantages of strict bed rest such as thrombosis, demineralization, cardiovascular deconditioning, constipation, gastric distention, and worsened glucose tolerance are also known. Visits at home by a midwife primarily provide emotional support. Weekly vaginal examinations have not shown a preterm birth-reducing effect. Infections of the urogenital organs should be treated with antibiotics resp. fungicides are treated. Therapy of urinary tract infections, asymptomatic bacteriuria&nbsp; (&gt;100,000 germs\/ml), bacterial vaginosis, Candida colpitis, and Streptococcus B colonization causes a reduction in preterm birth; for ureaplasma, the data are controversial.<\/p>\n<p>Sonographic cervical measurement <strong>(Fig.&nbsp;1)<\/strong> with the corresponding intervention options is becoming increasingly important: Progesterone therapy and insertion of a pregnancy pessary <strong>(Fig.&nbsp;2)<\/strong>. The application of a pessary is simple and shows a favorable effect in singleton pregnancies. Presumably, the pessary acts by sacral alignment of the cervix and by preventing further funneling (V-shaped shortening of the cervix) by forming edema. The edema also forms a barrier to infection. However, contractions are an exclusion criterion for the application of a foreign body: labor must therefore be slowed down before inserting a pessary.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-4854 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11.jpg\" style=\"--smush-placeholder-width: 1100px; --smush-placeholder-aspect-ratio: 1100\/717;height:391px; width:600px\" width=\"1100\" height=\"717\" data-srcset=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11.jpg 1100w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11-800x521.jpg 800w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11-120x78.jpg 120w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11-90x59.jpg 90w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11-320x209.jpg 320w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb1_hp11-560x365.jpg 560w\" data-sizes=\"(max-width: 1100px) 100vw, 1100px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-4855 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11.jpg\" style=\"--smush-placeholder-width: 1100px; --smush-placeholder-aspect-ratio: 1100\/1042;height:568px; width:600px\" width=\"1100\" height=\"1042\" data-srcset=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11.jpg 1100w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11-800x758.jpg 800w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11-120x114.jpg 120w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11-90x85.jpg 90w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11-320x303.jpg 320w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/abb2_hp11-560x530.jpg 560w\" data-sizes=\"(max-width: 1100px) 100vw, 1100px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/p>\n<h2 id=\"measures-in-case-of-threatened-premature-birth\">Measures in case of threatened premature birth<\/h2>\n<ul>\n<li>If there is a threat of preterm birth (preterm labor or rupture of membranes), the following three questions should be answered:<\/li>\n<li>Is there an indication for acute tocolysis (up to 33 weeks gestation + 6\/7&nbsp; days)?<\/li>\n<li>Is there an indication for the administration of corticosteroids for fetal lung maturation (up to 33 weeks gestation + 6\/7&nbsp; days)?<\/li>\n<li>Should the pregnant woman be transferred to a perinatal center?<\/li>\n<\/ul>\n<p>An overview of which investigations are useful in preterm labor is shown in <strong>table&nbsp;2 <\/strong>. Possible interventions are the administration of low-dose aspirin in case of appropriate risk (e.g. status after preeclampsia), docosahexaenoic acid and\/or vaginal progesterone in case of status after preterm birth or shortened cervix in the current pregnancy. In the case of a shortened cervix, the insertion of a cerclage pessary or a cerclage should also be evaluated, if necessary.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-4856 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11.png\" style=\"--smush-placeholder-width: 862px; --smush-placeholder-aspect-ratio: 862\/649;height:452px; width:600px\" width=\"862\" height=\"649\" data-srcset=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11.png 862w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11-800x602.png 800w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11-320x240.png 320w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11-300x225.png 300w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11-120x90.png 120w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11-90x68.png 90w, https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/11\/tab2_hp11-560x422.png 560w\" data-sizes=\"(max-width: 862px) 100vw, 862px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/p>\n<p>Several classes of agents are used for labor inhibition: Beta-adrenergic receptor agonists, oxytoxcin antagonists, calcium blockers, nitric oxide donors, prostaglandin synthetase inhibitors, magnesium sulfate, and herbal remedies such as Bryophyllum pinnatum. Because a calcium blocker such as nifedipine can be administered by os, this labor inhibitor is also used in practice. To date, there is no clear evidence for long-term tocolysis, but in practice, individual situations arise in which the advantages of long-term tocolysis may outweigh the disadvantages.<\/p>\n<p><strong>Franziska Kr\u00e4henmann, MD, FMH, IBCLC<\/strong><br \/>\n<strong>Marcella Siegrist-L\u00e4uchli, MD, FMH<\/strong><br \/>\n&nbsp;<\/p>\n<p><em>Further reading<\/em><\/p>\n<ul>\n<li>&#8220;Tocolysis in preterm labor,&#8221; Swiss Society of Gynecology and Obstetrics Expert Letter 41, 2013.<br \/>\n  http:\/\/sggg.ch\/files\/fckupload\/file\/2_Fachpersonen\/Expertenbriefe\/deutsch\/41_Expertenbrief_2013.pdf.<\/li>\n<\/ul>\n<p>\n<strong>CONCLUSION FOR PRACTICE<\/strong><\/p>\n<ul>\n<li>Preterm labor is present with regular contractions, painful contractions, and \u2265four contractions per 20 minutes.<\/li>\n<li>If prematurity is imminent, it must be clarified whether there are indications for tocolysis or tomodialysis. fetal lung maturation is present and whether the pregnant woman should be transferred to a perinatal center.<\/li>\n<li>In practice, it is important to identify and treat risk factors for preterm birth as early as possible.<\/li>\n<\/ul>\n<p>\n<em><strong>A RETENIR<\/strong><\/em><\/p>\n<ul>\n<li><em>Les contractions pr\u00e9coces se manifestent par un travail r\u00e9gulier, des contractions douloureuses et \u2265 quatre cycles de contractions en 20 minutes.<\/em><\/li>\n<li><em>En cas de menace d&#8217;accouchement pr\u00e9matur\u00e9 il convient d&#8217;\u00e9tablir si les indications pour une tocolyse, en l&#8217;occurrence une maturit\u00e9 pulmonaire f\u0153tale, sont r\u00e9unies et si la femme enceinte doit \u00eatre transport\u00e9e dans une unit\u00e9 de p\u00e9rinatologie.<\/em><\/li>\n<li><em>Dans la pratique, il est important d&#8217;identifier le plus t\u00f4t possible les facteurs de risque d&#8217;accouchement pr\u00e9matur\u00e9 et de les traiter.<\/em><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><em>HAUSARZT PRAXIS 2014; 9(11): 16-18<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Preterm labor is an indication of impending preterm birth. Various measures are possible to prevent premature birth, including tocolysis. In practice, it is useful to identify risk factors for preterm&hellip;<\/p>\n","protected":false},"author":7,"featured_media":47749,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Premature labor","footnotes":""},"category":[11508,11400,11548],"tags":[18401,49880,49875,46838,13446,49856,49858,49857,49859,49870,49860],"powerkit_post_featured":[],"class_list":["post-344252","post","type-post","status-publish","format-standard","has-post-thumbnail","category-education","category-gynecology","category-rx-en","tag-bmi-en","tag-cerclage-pessary","tag-cervix-en","tag-conization","tag-hypertension-en-2","tag-labor-en","tag-multiple-pregnancy","tag-premature-birth","tag-twins","tag-ureaplasma-en","tag-uterus-en","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-07-09 18:49:14","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"en_US","wpml_translations":{"fr_FR":{"locale":"fr_FR","id":344254,"slug":"quand-laccouchement-commence-trop-tot","post_title":"Quand l'accouchement commence trop t\u00f4t","href":"https:\/\/medizinonline.com\/fr\/quand-laccouchement-commence-trop-tot\/"},"it_IT":{"locale":"it_IT","id":344211,"slug":"quando-la-nascita-inizia-troppo-presto","post_title":"Quando la nascita inizia troppo presto","href":"https:\/\/medizinonline.com\/it\/quando-la-nascita-inizia-troppo-presto\/"},"pt_PT":{"locale":"pt_PT","id":344230,"slug":"quando-o-nascimento-comeca-demasiado-cedo","post_title":"Quando o nascimento come\u00e7a demasiado cedo","href":"https:\/\/medizinonline.com\/pt-pt\/quando-o-nascimento-comeca-demasiado-cedo\/"},"es_ES":{"locale":"es_ES","id":344243,"slug":"cuando-el-parto-comienza-demasiado-pronto","post_title":"Cuando el parto comienza demasiado pronto","href":"https:\/\/medizinonline.com\/es\/cuando-el-parto-comienza-demasiado-pronto\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/344252","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/comments?post=344252"}],"version-history":[{"count":1,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/344252\/revisions"}],"predecessor-version":[{"id":344299,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/344252\/revisions\/344299"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media\/47749"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media?parent=344252"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/category?post=344252"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/tags?post=344252"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/powerkit_post_featured?post=344252"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}