• Diagnosis of Preterm Labor and Delivery

    To diagnose preterm labor, your doctor will review your symptoms. A pelvic exam will be done. You may also have some testing and monitoring done.

    Pelvic Exam

    The pelvic exam is done to see if your cervix has begun to dilate or to thin. If dilation has begun, you may be in preterm labor. Dilation is measured in centimeters from 0-10. Birth usually occurs after the cervix has dilated to 10 centimeters. Thinning of the cervix is called effacement. It is reported as a percent. If you are 50% effaced, your cervix has thinned to half of its original thickness. When you reach 100% effaced, the cervix is completely thinned and ready for a vaginal delivery.
    Sometimes, the length of the cervix is assessed by an ultrasound measurement.

    Fetal Fibronectin

    During the pelvic exam, your doctor may swab your cervix to test for fetal fibronectin (fFN). fFN acts as a glue to attach the amniotic sac to the lining of the uterus. It is normal for fFN to be in cervical secretions for the first 22 weeks of pregnancy. However, if fFN is present in the outer cervix beyond weeks 22-34, this glue may be breaking down earlier than it should. fFN may be a sign of impending preterm labor.
    The presence of fFN (positive test result) is not a good predictor of whether you are at risk of preterm birth. However, the absence of fFN (negative test result) is a good predictor that you are not at risk of a preterm birth at this time. Your pregnancy is likely to continue for at least another two weeks.

    Other Monitoring

    An ultrasound may also be done. This test uses sound waves to create an image of your uterus, the fluid around the baby, and the baby inside. Your doctor can then examine this image.

    References

    American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 31: Assessment of risk factors for preterm birth. Obstet Gynecol2001 Oct;98(4):709-16.

    American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 127: Management of preterm labor. Obstet Gynecol. 2012 Jun;119(6):1308-17.

    Home uterine monitors not useful for predicting premature birth. National Institutes of Health website. Available at: http://www.nih.gov/news/pr/jan2002/nichda23.htm . Published January 23, 2012. Accessed October 9, 2012.

    Premature labor. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/prematurelabor.html. Updated May 2007. Accessed October 9, 2012.

    Preterm labor. The American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq087.pdf?dmc=1&ts=20121009T0455409103 . Accessed October 9, 2012.

    Preterm labor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 13, 2012. Accessed October 9, 2012.

    Preterm labor and birth. National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/health/topics/preterm%5Flabor%5Fand%5Fbirth.cfm. Accessed October 9, 2012.

    Weismiller DG. Preterm labor. Am Fam Physician. 1999 Feb 1;59(3):593-602. Available at: http://www.aafp.org/afp/990201ap/593.html . Accessed October 9, 2012.

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