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The early diagnosis of impending premature labour
1Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Headington, U.K.
Early diagnosis of impending premature labour offers the possibility of early and effective tocolysis. This paper reviews recent work which has suggested that excessive uterine contractility or early cervical dilatation during pregnancy would provide this early diagnosis. Since marked uterine contractility and cervical dilatation can occur in pregnancy which proceeds to term, however, these features may not be specific enough predictors of preterm labour for clinical use. The evidence is also reviewed that the presence or absence of fetal breathing movements (FBM) predicts the outcome of preterm labour. This finding has now been confirmed in four centres outside Oxford. For women admitted in preterm labour, an expertly performed real-time ultrasound scan has now become an essential investigation. Since more than 50% of preterm 'labours' appear to subside spontaneously without tocolysis, a knowledge of the presence or absence of FBM should avoid unnecessary treatment and ensure that clinical efforts are concentrated on patients most in need.
Early diagnosis of impending premature labour offers the possibility of early and effective tocolysis. This paper reviews recent work which has suggested that excessive uterine contractility or early cervical dilatation during pregnancy would provide this early diagnosis. Since marked uterine contractility and cervical dilatation can occur in pregnancy which proceeds to term, however, these features may not be specific enough predictors of preterm labour for clinical use. The evidence is also reviewed that the presence or absence of fetal breathing movements (FBM) predicts the outcome of preterm labour. This finding has now been confirmed in four centres outside Oxford. For women admitted in preterm labour, an expertly performed real-time ultrasound scan has now become an essential investigation. Since more than 50% of preterm 'labours' appear to subside spontaneously without tocolysis, a knowledge of the presence or absence of FBM should avoid unnecessary treatment and ensure that clinical efforts are concentrated on patients most in need.
