Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- history of preterm labor, cervical trauma, or induced abortion
- multifetal pregnancy and presence of maternal infection
- uterine contractions
- preterm prelabor rupture of membranes (PPROM)
- advanced cervical dilation
- cervical length <2 cm
Outros fatores diagnósticos
- increased maternal or fetal heart rate
- nonspecific lower abdominal or back pain
- fever
- vaginal bleeding
Fatores de risco
- previous preterm labor
- previous cervical trauma
- previous induced abortion
- maternal infections
- multifetal pregnancies
- short cervical length
- positive fetal fibronectin test
- preterm prelabor rupture of membranes (PPROM)
- fetal abnormalities
- smoking
- body mass index (BMI) <19 kg/m²
- social factors and ethnicity
- fertility treatment
- polyhydramnios
- domestic violence
- poor dental hygiene
- late-stage cesarean section
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- nonstress cardiotocogram
- tocography
- transvaginal ultrasound of the cervix
- cervico-vaginal swab for fetal fibronectin
- CBC
- CRP
- urine dipstick
- urine microscopy, culture, and sensitivity
- high vaginal/rectal culture
Investigações a serem consideradas
- 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)
Algoritmo de tratamento
threatened preterm labor (TPTL)
preterm prelabor rupture of membranes (PPROM)
high risk of imminent delivery without PPROM
Colaboradores
Autores
Andrew H. Shennan, MD, FRCOG
Professor of Obstetrics
King's College London
London
UK
Declarações
AHS has given talks for Hologic, the manufacturer of fetal fibronectin, and has received funds to his institute for research. 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
Declarações
JCG declares that she has no competing interests.
Revisores
Jo Trinder, MD
Consultant Obstetrician and Gynaecologist
St Michael's Maternity Wing
Bristol Royal Infirmary
Bristol
UK
Declarações
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
Declarações
KD declares that she has no competing interests.
Deidre Lyell, MD
Assistant Professor of Maternal-Fetal Medicine
Stanford University
Stanford
CA
Declarações
DL declares that she has no competing interests.
Referências
Principais artigos
National Institute for Health and Care Excellence. Preterm labour and birth. Jun 2022 [internet publication].Texto completo
Shennan AH, Story L, Royal College of Obstetricians, Gynaecologists. Cervical cerclage: green-top guideline no. 75. BJOG. 2022 Jun;129(7):1178-210.Texto completo Resumo
EPPPIC Group. Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trials. Lancet. 2021 Mar 27;397(10280):1183-94.Texto completo Resumo
Royal College of Obstetricians and Gynaecologists. Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation. Green-top guideline no. 73. Jun 2019 [internet publication].Texto completo
American College of Obstetricians and Gynecologists' Committee on Committee Opinion-Obstetrics. ACOG committee opinion no. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2017 Aug;130(2):e102-9.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Placental abruption
- Urinary tract infection (UTI)
- Ovarian cyst
Mais Diagnósticos diferenciaisDiretrizes
- Guideline no. 430: diagnosis and management of preterm prelabour rupture of membranes
- Practice bulletin no. 231: multifetal gestations twin, triplet, and higher-order multifetal pregnancies
Mais DiretrizesFolhetos informativos para os pacientes
Premature labor
Mais Folhetos informativos para os pacientesConectar-se ou assinar para acessar todo o BMJ Best Practice
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