Depending on how far along you are in your pregnancy, your doctor or midwife may not attempt to stop your preterm labor. If you aren’t close to term, one of the first things that may be done is re-hydration. You may be given fluids and possibly an IV. Preterm contractions can many times be directly related to dehydration. If your contractions stop after re-hydration, you will more than likely be discharged with orders to increase your fluid intake and follow up with a visit with your doctor or midwife, without any medications. If you are thought to be in labor preterm (before the 37th week of pregnancy), you may be given antibiotics to prevent (or treat) possible infection, especially if your membranes have ruptured.
If re-hydrating you doesn’t stop contractions, then you will most likely be given medication. There are typically two types of medications given to women who are having preterm labor. The first type helps to slow down or stop labor contractions if given early enough (they are called “tocolytics”) .The second type helps the baby’s lungs mature before birth (“corticosteroid” medications).
Tocolytic medications often used include terbutaline (or brethine), ritodrine, nifedipine, magnesium sulfate, or indomethacine. Each of these medications work in a different way, but the goal is to minimize the strength and number of contractions which may cause the cervix to dilate and efface. They may be given in an injection, by IV, under the skin or in the form of a pill. Your doctor or midwife may prescribe your medication to be administered by a ‘pump’, which delivers a small amount automatically through a device similar to that used by insulin dependent diabetics, while you stay in the hospital. Tocolytic medications are not as successful later in labor, if your membranes have broken, or if your cervix is already dilated beyond 2 centimeters. Tocolytics are not used if you have chorioamnionitis (an infection in the membranes around the baby), bleeding, abruptio placenta, severe preeclampsia or eclampsia, cardiac disease or other severe medical illnesses.
Like other drugs, these medications are associated with side effects for you, as well as your baby. Before choosing a medication, you and your doctor or midwife must weigh the risks and benefits of each. Possible side effects of some of these drugs include (but are not limited to): drowsiness, dizziness, headaches, muscle weakness, irregular or fast heartbeat, nausea, vomiting, nervousness, restlessness, insomnia, shaking, shortness of breath, hyperglycemia (high blood sugar) and hypokalemia (low blood potassium), double vision, fluid in the lungs, fever, hallucinations and heart attack. Possible side effects for the baby include: fast heart rate, high or low blood sugar after birth, loss of muscle tone, slow breathing, drowsiness, enlarged heart, jaundice and bleeding within the brain or heart. You and your baby should be monitored very closely while taking any of these medications.
By delaying preterm labor with tocolytic medications, doctors and midwives can use other medications to help speed up the baby’s lung development and improve the baby’s chance of survival. Corticosteroid (or steroid) medications are given, particularly if delivery appears to be inevitable. Betamethasone (also called celestone) or dexamethasone are given by injection into muscle tissue.
Sometimes, if an incompetent cervix has been diagnosed, a cervical cerclage may be done. This is a procedure where the cervical opening is stitched to keep it closed. Early cerclage placement has a significantly higher success rate than those performed after effacement and dilation have occurred. Bedrest (either at home or in the hospital) may be recommended, with varying levels of activity (from limited to none). It is important for you to discuss with your doctor or midwife what range of activity you may participate in when bedrest is prescribed.
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