title: Tocolysis for Women With Early Spontaneous Preterm Labor and Advanced Cervical Dilation.
abstract: OBJECTIVE
  To characterize tocolytic use and examine perinatal outcomes among women presenting very preterm with spontaneous labor and cervical dilation 4 cm or greater.
  
  
  METHODS
  This was a retrospective cohort study. Data from January 2000 to June 2011 in a single health care system were reviewed. Women with singleton, nonanomalous fetuses and preterm labor with intact membranes between 23 and 32 weeks of gestation who had cervical dilation 4 cm or greater and less than 8 cm at admission were included. Women receiving one or more tocolytics (magnesium sulfate, indomethacin, or nifedipine) were compared with those who did not receive tocolysis. The primary outcome was composite major neonatal morbidity.
  
  
  RESULTS
  Two hundred ninety-seven women were included; 233 (78.5%) received at least one tocolytic. Women receiving tocolysis were slightly less dilated (median 5 compared with 6 cm, P<.001) at presentation and were more likely to receive at least a partial course of corticosteroids (88.4% compared with 56.3%, P<.001). Initial composite severe neonatal morbidity rates were similar (41.6% compared with 43.8%, P=.761) regardless of tocolytic administration. Those receiving tocolysis were significantly more likely to be pregnant at least 48 hours after admission (23.6% compared with 7.8%, P=.005), but a similar proportion delivered within 7 days of admission (94.8% compared with 95.3%, P>.99), and delivery gestational ages were similar (28.9 compared with 29.2 weeks, P=.408). The incidence of chorioamnionitis and postpartum endometritis was similar between groups.
  
  
  CONCLUSIONS
  The majority of women presenting very preterm with advanced cervical dilation received tocolysis. Although tocolysis administration increased the likelihood of achieving at least 48 hours of latency, initial neonatal outcomes were similar.
  
  
  METHODS
  II.
authors.affiliation: Departments of Obstetrics and Gynecology and Internal Medicine, University of Utah, and the Department of Pediatrics, Intermountain Healthcare, Salt Lake City, and the Department of Maternal Fetal Medicine, Intermountain Healthcare, Murray, Utah.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Manuck
authors.forename: Christina A
authors.initials: CA
authors.lastname: Herrera
authors.forename: E Kent
authors.initials: EK
authors.lastname: Korgenski
authors.forename: Marc
authors.initials: M
authors.lastname: Jackson
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: T Flint
authors.initials: TF
authors.lastname: Porter
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015145:Tocolysis / Q000706:statistics & numerical data*; D015149:Tocolytic Agents / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015149:Tocolytic Agents