Preterm contractions in community settings: I. Treatment of preterm contractions

OBJECTIVE: To explore how physicians in community hospitals (non-level III nursery facilities) diagnose preterm labor and treat women with preterm contractions. METHODS: Chart audits were performed for women presenting with preterm contractions at a network of 11 Wisconsin non-level III hospitals. RESULTS: Ninety percent (239 of 266) of the women presenting with premature contractions agreed to participate. The average gestational age was 31.6 weeks' gestation. Only 44 (17%) of these women had any cervical change with their contractions. However, tocolytic agents were used frequently, regardless of whether cervical changed occurred (61%) or not (76%, P=.10), and tocolytics were prescribed frequently upon discharge for those patients who left the hospital (54% of those with cervical change versus 62% in those without changes, P=.57). Examining the use of appropriate treatments for women who did deliver prematurely, we found that only 26% of women who delivered prematurely received antenatal antibiotics to prevent group B streptococcal disease in the newborn, and only 33% of those who delivered at 34 weeks' gestation or earlier received corticosteroids to accelerate fetal lung maturity. CONCLUSION: Women presenting at community hospitals with preterm contractions but no evidence of labor are overtreated frequently with agents of equivocal benefit, whereas those who have active labors and deliver are not receiving agents such as steroids or antibiotics that have been shown to benefit outcomes.

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