• Screening for Preterm Labor and Delivery

    The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people who do not have current symptoms, but who may be at high risk for certain diseases or conditions.
    All pregnant women are screened for factors that may increase their risk of preterm labor. For women at low risk of preterm labor, there are no recommendations for further screening.
    The benefit of screening high-risk women for preterm labor is controversial. Some methods of screening for preterm labor that may be used to screen high risk women include:

    Risk Factor Assessment

    A structured list of risk factors can be checked at the first prenatal visit and later in pregnancy. A risk score can be determined for preterm delivery.
    In order for risk identification to be helpful, it must be combined with a program to modify any risk factors that can be modified. These programs are usually community-based. Examples include the Alabama Preterm Birth Prevention Project, the Better Birth Outcomes trials, and other community-based initiatives.

    Fetal Fibronectin

    During a 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.

    Cervical Length

    At the first prenatal visit, your doctor may measure your cervix using an ultrasound. During pregnancy, your cervix is monitored for changes. If your cervix is getting shorter, that means it is beginning to efface (thin out). This places you at higher risk for preterm delivery.

    Home Uterine Activity Monitoring

    A uterine activity monitor can measure and time your contractions. The monitor is strapped around your belly and worn at home. It can be worn for up to ten weeks. Information from the monitor is sent to a central monitoring office where a nurse looks for signs of preterm labor.
    Home uterine activity monitoring is not recommended in women with or without risk factors for preterm labor. A study by the National Institute of Child Health and Human Development (NICHD) found that uterine monitors did not predict preterm labor. The US Preventive Services Task Force stated that there is not enough evidence to either recommend or advise against home uterine activity monitoring as a screening test for preterm labor in high-risk pregnancies. The American Congress of Obstetricians and Gynecologists (ACOG) does not recommend the use of this device.

    References

    American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 31: Assessment of risk factors for preterm birth. Obstet Gynecol 2001 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 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.

    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.

    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.

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.