What is threatened preterm labor?

Threatened preterm labor (TPL) is the presence of regular uterine movement associated with cervical modification, either in terms of cervical shortening and/or dilatation in pregnancies from 22 to 36.6 weeks of gestation.

TPL is usually of multifactorial origin, and the main causes are due to uterine overdistension (for example, due to polyhydramnios or twin pregnancy), infection of another part of the body (for example, appendicitis), or due to subclinical intra-amniotic infection or inflammation.

Preterm birth

Preterm birth is one of the main causes of neonatal morbidity and mortality that can lead to a high percentage of childhood consequences. Therefore it is essential to take a good history of the pregnant woman and assess the situation when she comes to the emergency services because of pain or sensation of uterine contractions. Several tests will be performed, among them, a measurement of cervical length by transvaginal ultrasound scan, as well as an abdominal ultrasound scan assessment, collection of lab samples (including blood and urine analysis and a collection of vaginal and cervical swabs), as well as cardiotocographic monitoring of the fetus or fetuses in case of multiple pregnancies. Currently, there is insufficient evidence for routine amniocentesis, so this is decided on an individual level according to each case and severity.

In certain circumstances, hospital admission for tocolytic treatment may be an option and may require relative or complete bed rest. The situation needs to be closely monitored, and this is an excellent time to provide the necessary basic information related to infant feeding, especially if a premature birth is expected.

Breastfeeding support in case of prematurity

If this is the case, good support, and clear instructions are essential to help the mother initiate breastfeeding:

• Breast stimulation should be started as soon as possible, if possible, before 6 hours after birth.
• The correct technique of manual breast milk removal (hand expression) should be explained, as this may favor the collection of the initial colostrum drops.
• It is important to understand the mother’s situation before birth and to know if there are any risk factors that increase the possibility of delaying or hindering lactogenesis II (medications such as corticosteroids taken just before delivery, magnesium sulfate before or during delivery, possible hypothyroidism, diabetes mellitus or gestational diabetes, and so on).
• If lactogenesis II is detected, a breast pump can be offered to facilitate milk removal and maintenance of lactation, ideally with a hospital-grade double breast pump.
• Facilitate as much as possible the reuniting of the mother-newborn dyad, as well as facilitating skin-to-skin contact and the first feeds at the breast.

Initiating breastfeeding in the context of risk pregnancy due to the threat of preterm birth is challenging for both families and healthcare providers, and it is part of our competencies to accompany them on an individual basis for each family.

 

References

Mayo A. Amenaza de parto pretérmino [Internet]. Sego.es. [citado el 21 de marzo de 2024]. Disponible en: https://sego.es/documentos/gap/3-PDF-Amenaza-de-parto-pretermino21.pdf

AALP. PROTOCOLO: ASISTENCIA AL PARTO DEL PREMATURO EN GESTACIONES ÚNICAS [Internet]. Fetalmedicinebarcelona.org. [citado el 21 de marzo de 2024]. Disponible en: https://fetalmedicinebarcelona.org/wp-content/uploads/2024/02/atencion-parto-prematuro.pdf

Wilson, A., Hodgetts-Morton, V. A., Marson, E. J., Markland, A. D., Larkai, E., Papadopoulou, A., Coomarasamy, A., Tobias, A., Chou, D., Oladapo, O. T., Price, M. J., Morris, K., & Gallos, I. D. (2022). Tocolytics for delaying preterm birth: a network meta-analysis (0924). The Cochrane database of systematic reviews, 8(8), CD014978. https://doi.org/10.1002/14651858.CD014978.pub2

Boies EG, Vaucher YE, the Academy of Breastfeeding Medicine. ABM clinical protocol #10: Breastfeeding the late preterm (34–36 6/7 weeks of gestation) and early term infants (37–38 6/7 weeks of gestation), second revision 2016. Breastfeed Med [Internet]. 2016;11(10):494–500