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
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
- placental alpha microglobulin-1 (PAMG-1)
Treatment algorithm
Contributors
Authors
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
Consultant Obstetrician and Gynaecologist
St Michael's Maternity Wing
Bristol Royal Infirmary
Bristol
UK
Disclosures
JT is the primary author of one randomised controlled trial cited in this topic. 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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