Tocolysis with advanced cervical dilatation.
OBJECTIVE
To assess the feasibility and potential benefit of delaying delivery in women with advanced preterm labor.


METHODS
Two hundred fifty-seven gravidas with intact membranes and preterm labor at cervical dilatations of at least 3 cm were studied. Women were excluded if they had premature rupture of membranes, gestational age less than 24 or more than 35.9 weeks, complete cervical dilatation, severe hemorrhage, chorioamnionitis, and triplets or higher-order gestations. Management consisted of tocolysis with intravenous magnesium sulfate as the primary agent, antenatal steroids, antibiotics, and amniocentesis. The primary endpoint was delay to delivery interval. Statistical analyses by cervical dilatation were performed using the Pearson chi2 test and a nonparametric test of trend.


RESULTS
Eighty-one percent of pregnancies were referrals in utero from outlying hospitals. Delivery was delayed 24 hours or longer in 74% and beyond 48 hours in 60% of cases. Among 229 women who delivered at our center, 21% remained undelivered after 1 week. Evaluating delay as a function of cervical dilatation, trend analysis found a highly significant inverse relationship (P < .001). Among women dilated 5 cm, 46% delivered beyond 48 hours. Among those dilated 6 cm or more, 19% delivered beyond 48 hours. Mild pulmonary edema developed in five percent, and all responded promptly to medical interventions. Chorioamnionitis developed in eight percent.


CONCLUSIONS
Delaying delivery 24-48 hours to allow antenatal steroid use or other interventions is possible in women with advanced preterm labor.
Amon
E
E
Department of Obstetrics and Gynecology, St. Louis University School of Medicine, Missouri, USA.
Midkiff
C
C
Winn
H
H
Holcomb
W
W
Shumway
J
J
Artal
R
R
D002584:Cervix Uteri; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D015145:Tocolysis; D015149:Tocolytic Agents / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
D015149:Tocolytic Agents; D008278:Magnesium Sulfate