Management of preterm labor

Management of preterm labor involves several steps.
Step 1: Confirm labor using the three criteria listed earlier—gestational age,
contraction frequency, cervical exam.
Step 2: Rule out contraindications to tocolysis. Do not try to prolong
pregnancy if obstetric, fetal, maternal complications are present.
Step 3: Start IV MgSO4 if <32 weeks for fetal neuroprotection of cerebral
palsy. Administer at least four hours before anticipated birth.
Step 4: Administer IM betamethasone if <34 weeks to stimulate fetal type II
pneumocyte surfactant production. A 48-hr course is needed for full effect to
take place.
Step 5: Start tocolytic therapy if <34 weeks to prolong pregnancy to allow for
antenatal steroid effect. There is no benefit exceeding 48 hours. MgSO4,
terbutaline, or nifedipine can be used up to 34 weeks. Indomethacin should
not be used after 32 weeks due to concerns regarding in-utero closure of the
Step 6: Start IV penicillin G if <36 weeks for GBS sepsis prophylaxis (use
vancomycin if allergic to penicillin G). First obtain recto-vaginal cultures