Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • uterine contractions
  • preterm premature rupture of membranes (PPROM)
  • advanced cervical dilation
  • cervical length <2 cm

Other diagnostic factors

  • increased maternal or fetal heart rate
  • non-specific lower abdominal or back pain
  • fever
  • vaginal bleeding

Risk factors

  • previous premature labour
  • previous cervical trauma
  • previous induced abortion
  • maternal infections
  • multifetal pregnancies
  • short cervical length
  • positive fetal fibronectin test
  • preterm premature rupture of membranes (PPROM)
  • fetal abnormalities
  • smoking
  • body mass index (BMI) <19 kg/m^2
  • social factors and ethnicity
  • polyhydramnios
  • domestic violence
  • poor dental hygiene

Diagnostic investigations

1st investigations to order

  • non-stress cardiotocogram
  • tocography
  • transvaginal ultrasound of the cervix
  • cervico-vaginal swab for fetal fibronectin
  • FBC
  • CRP
  • urine dipstick
  • urine microscopy, culture, and sensitivity
  • high vaginal/rectal swab
Full details

Investigations to consider

  • nitrazine test
  • microscopy of vaginal fluid
  • Kleihauer blood test
  • urine toxicology screen
  • IGFBP-1 (insulin-like growth factor binding protein-1) test
Full details

Emerging tests

  • placental alpha microglobulin-1 (PAMG-1)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Obstetrics

King's College London

London

UK

Disclosures

AHS gives educational talks financially supported by Hologic and is UK chief investigator for a tocolysis trial sponsored by GlaxoSmithKline. AHS is an author of a number of references cited in this monograph.

Consultant in Obstetrics and Gynaecology

West Middlesex University Hospital

London

UK

Disclosures

JCG declares that she has no competing interests.

Peer reviewers VIEW ALL

Consultant Obstetrician and Gynaecologist

St Michael's Maternity Wing

Bristol Royal Infirmary

Bristol

UK

Disclosures

JT is the primary author of one RCT cited in this monograph. This trial was funded by an NHS Research and Development Grant and a donation from Exelgyn, the manufacturer of misoprostol. JT has accepted honoraria for speaking to groups of midwives and doctors about miscarriage management.

Consultant Obstetrician and Gynaecologist

Royal Infirmary of Edinburgh

Honorary Senior Lecturer

University of Edinburgh

Edinburgh

UK

Disclosures

KD declares that she has no competing interests.

Assistant Professor of Maternal-Fetal Medicine

Stanford University

Stanford

CA

Disclosures

DL declares that she has no competing interests.

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