Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- contrações uterinas
- ruptura prematura de membranas
- dilatação cervical avançada
- comprimento cervical <2 cm
Other diagnostic factors
- frequência cardíaca fetal ou materna elevada
- dor na parte inferior do abdome ou dorsalgia inespecífica
- febre
- sangramento vaginal
Risk factors
- parto prematuro prévio
- trauma cervical prévio
- aborto induzido prévio
- infecções maternas
- gestações multifetais
- comprimento cervical curto
- exame de fibronectina fetal positivo
- ruptura prematura de membranas
- anormalidades fetais
- tabagismo
- índice de massa corporal (IMC) <19 kg/m²
- fatores sociais e etnia
- tratamento de fertilidade
- polidrâmnio
- violência doméstica
- higiene dental insuficiente
- parto cesáreo em estágio tardio
Diagnostic investigations
1st investigations to order
- cardiotocografia sem estresse
- tocografia
- ultrassonografia transvaginal do colo uterino
- exame de swab cérvico-vaginal para fibronectina fetal
- Hemograma completo
- proteína C-reativa
- tira reagente para exame de urina
- microscopia de urina, cultura e sensibilidade
- exame de swab vaginal/retal alto
Investigations to consider
- microscopia do fluido vaginal
- exame de sangue de Kleihauer
- exame toxicológico da urina
- teste de proteína de ligação do fator de crescimento semelhante à insulina (IGFBP-1)
- alfa-1 microglobulina placentária (PAMG-1)
Treatment algorithm
ameaça de parto pré-termo (APPT)
ruptura prematura de membranas
alto risco de parto iminente sem ruptura prematura de membranas
Contributors
Authors
Andrew H. Shennan, MD, FRCOG
Professor of Obstetrics
King's College London
London
UK
Disclosures
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
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.
References
Key articles
National Institute for Health and Care Excellence. Preterm labour and birth. Jun 2022 [internet publication].Full text
Shennan AH, Story L, Royal College of Obstetricians, Gynaecologists. Cervical cerclage: green-top guideline no. 75. BJOG. 2022 Jun;129(7):1178-210.Full text Abstract
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.Full text Abstract
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].Full text
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Descolamento da placenta
- Infecção do trato urinário (ITU)
- Cisto ovariano
More DifferentialsGuidelines
- Twin and triplet pregnancy
- Cervical cerclage (Green-top guideline no. 75)
More GuidelinesPatient information
Parto prematuro
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