Last reviewed: 30 Jun 2021
Last updated: 03 Feb 2021

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
  • late-stage caesarean section

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

Investigations to consider

  • microscopy of vaginal fluid
  • Kleihauer blood test
  • urine toxicology screen
  • insulin-like growth factor binding protein-1 (IGFBP-1) test
  • placental alpha microglobulin-1 (PAMG-1)

Treatment algorithm

Contributors

Authors

Andrew H. Shennan, MD, FRCOG

Professor of Obstetrics

King's College London

London

UK

Disclosures

AHS has received a grant from Hologic to evaluate fetal fibronectin. AHS is an author of several references cited in this topic.

Joanna C. Girling, MA, MRCP, FRCOG

Consultant in Obstetrics and Gynaecology

West Middlesex University Hospital

London

UK

Disclosures

JCG declares that she has no competing interests.

Peer reviewers

Jo Trinder, MD

Consultant Obstetrician and Gynaecologist

St Michael's Maternity Wing

Bristol Royal Infirmary

Bristol

UK

Disclosures

JT has accepted honoraria for speaking to groups of midwives and doctors about miscarriage management.

Kirsty Dundas, MBChB, DCH, FRCOG

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.

Deidre Lyell, MD

Assistant Professor of Maternal-Fetal Medicine

Stanford University

Stanford

CA

Disclosures

DL declares that she has no competing interests.

Use of this content is subject to our disclaimer