Management options in women with preterm uterine contractions: a randomized clinical trial

D. A. Guinn, A. R. Goepfert, J. Owen, C. G. Brumfield, J. C. Hauth

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

OBJECTIVE: To evaluate three management strategies and assess pregnancy outcomes in women who present with preterm uterine contractions (UC). STUDY DESIGN: We randomized women who presented to our L&D triage to observation alone (OBS) or the addition of either intravenous hydration (IVF), or one dose of subcutaneous terbutaline (TRB). Eligible patients had a singleton pregnancy, intact membranes, were at >20 and <34 weeks' gestation, had >3 UC30 minutes, and were dilated 1 cm and effaced <80%. Women who developed preterm labor (PTL) had progressive cervical change at <34 weeks and were admitted and treated with intravenous MgSO4. Women remained in their assigned group for subsequent triage visits. We calculated that a sample size of 153 women would be required to demonstrate a two week intergroup difference in mean days to delivery (DEL) (α = 0.05 and β= 0.2). RESULTS: We randomized 179 women: 62 IVF, 56 OBS, and 61 TRB. The groups were similar with respect to maternal age, race, parity, prior preterm births, gestational age (29.8 ±2.9 weeks), UC (6.6 ±3.530 min), and mean initial cervical dilation (0.2 ±0.4 cm). Outcome IVF OBS TRB p value Days to DEL 56 ±27 60 ±25 60 ±26 0.6 Repeat triage visits 1.7 + 1.1 1.4 + 0.7 1.9 + 1.2 0.1 PTL <34 weeks 13% 18% 15% 0.7 DEL <34 weeks 6.4% 8.9% 6.6% 0.8 DEL <37 weeks 31% 23% 16% 0.2 Women who received TRB stopped contracting and were discharged earlier (TRB 4.1 ±5 hrs, OBS 5.2 ±5 hrs, IVF 6.0 ±6 hrs; p - 0.003). No complications related to IVF or TRB were observed. CONCLUSIONS: The use of IVF in the management of preterm UC was of no benefit. TRB is inexpensive, safe and resulted in the shortest length of stay in the triage unit.

Original languageEnglish (US)
Pages (from-to)S44
JournalActa Diabetologica Latina
Volume176
Issue number1 PART II
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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