MANAGEMENT OPTIONS IN WOMEN WITH PRETERM UTERINE CONTRACTIONS - A RANDOMIZED CLINICAL-TRIAL

OBJECTIVE: Our purpose was to evaluate three management strategies and to assess pregnancy outcomes in women with preterm uterine contractio ns. STUDY DESIGN: Consenting women seen in our hospital triage area wi th preterm uterine contractions were randomly assigned to observation alone, intravenous hydration, or one dose oi subcutaneous terbutaline sulfate (0.25 mg). Eligible women had a singleton gestation between 20 and 34 weeks, intact membranes, more than three contractions in 30 mi nutes, and a cervical dilation less than or equal to 1 cm and effaceme nt <80%. Women who had progressive cervical change at <34 weeks were t reated with in?ravenous tocolysis. Women with recurrent preterm uterin e activity remained in their assigned group during subsequent triage v isits. RESULTS: One hundred seventy-nine women were randomized: observ ation (56), hydration (62), and terbutaline (61). Women in these three groups were similar with respect to maternal age, race, parity, prior preterm births, gestational age at randomization, contraction frequen cy, and mean cervical dilatation. There were no intergroup differences in the mean days to delivery, the number of repeat triage visits, the incidence of preterm labor at (34 weeks, or the frequency oi preterm deliveries at <34 weeks and <37 weeks. Women assigned to terbutaline h ad contractions stopped and were discharged earlier [terbutaline 4.1 /- 5.1 hours, observation 5.2 +/- 5.3 hours, hydration 6.0 +/- 5.7 hou rs; p = 0.006). No complications of therapy were observed, CONCLUSIONS : The use of intravenous hydration in the management of preterm contra ctions was of no benefit. The use oi one dose of subcutaneous terbutal ine resulted in the shortest length of triage stay but did not affect pregnancy outcome.