Medicolegal issues in preterm birth of multiples.(Obstetrics)

KAILUA KONA, HAWAII -- An important step in detecting preterm labor in a multifetal pregnancy is to increase the patient's awareness of contractions and pelvic pressure and the need to report these symptoms, Dr. Michael A. Belfort said.

Most women who are pregnant for the first time don't know what contractions feel like or what to do if they get them. Spend time describing the sensations and instruct the patient about who to call, he said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

Dr. Belfort, professor of obstetrics and gynecology at the University of Utah, Salt Lake City, said medicolegal issues related to preterm birth in multifetal pregnancies tend to fall in the following categories:

* Prevention and diagnosis. There is little benefit from routine bed rest or hospitalization to prevent preterm labor in a multifetal pregnancy, the published evidence shows. It may make sense to hospitalize a woman with a high-risk pregnancy if there is a reason to continuously monitor contractions or fetal heart rate, but admitting someone with only occasional contractions just to have that person in the hospital generally is not helpful, he said. For patients with regular contractions, admission for a full evaluation may be the safest initial step.

Home uterine monitoring has not been shown to help improve outcomes in preterm birth, and the American College of Obstetricians and Gynecologists does not recommend its use. If you plan to follow cervical length measurements by ultrasound, consider also obtaining fetal fibronectin measurements. Some data are available that combine the two measures to estimate the risk of preterm birth, Dr. Belfort said at the meeting, which was sponsored by Boston University.

* Steroids. For singletons, it's the standard of care to give a single course of antenatal steroids when there's a high risk of preterm birth between 24 and 34 weeks' gestation if the membranes are intact or between 24 and 32 weeks when the membranes are ruptured and there is no ...