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Preterm labor

Última revisão: 11 Jun 2025
Última atualização: 19 Mar 2025

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
Detalhes completos

Outros fatores diagnósticos

  • increased maternal or fetal heart rate
  • nonspecific lower abdominal or back pain
  • fever
  • vaginal bleeding
Detalhes completos

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
Detalhes completos

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
Detalhes completos

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)
Detalhes completos

Algoritmo de tratamento

AGUDA

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

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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 diferenciais
  • Diretrizes

    • 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 Diretrizes
  • Folhetos informativos para os pacientes

    Premature labor

    Mais Folhetos informativos para os pacientes
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