Standard treatment for preterm contractions?

Specialties Ob/Gyn

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Specializes in Med/Surg, International Health, Psych.

I would greatly appreciate your advice. I am currently living and working in a US territory and while nice to live, the health system is seriously lacking. I suspect that I am receiving sub-standard care during my pregnancy and am contemplating getting on the first plane out of here.

What is the standard treatment for pre-term contractions? I am a 37 y/o, 24 weeks, multigravida. Third pregnancy, the other two were 40-41 week term spontaneous lady partsl births. Last one was 12 years ago. I have uterine fibroids, but have never been told how or if this could impact this pregnancy.

Having been experiencing painful contractions for last 4 days and unable to sleep because of them. They started out coming q1-2 minutes, lasting 45 secs-1 minute. By day 3, having struggled throughout the work day with constant pain, I dragged myself to the hospital.

Husband not allowed to enter with me because he is a man. I was placed under observation, R/L 1,000 125cc/hr, 75 mg Vistaril IM, U/A (neg for infection) and checked twice for cervical dilation. Cervical os found to be closed both times. Discharged with 30 tablets of 50mg of Vistaril and told this can happen to many women, some carry to term normally, and to return if contractions continue and watch for bleeding and amniotic fluid leaks. Told nothing about the constant pain and pressure.

This is my fourth evening with these contractions. OB/GYN not available. They are q4-5 minutes, lasting 30 seconds to 1 minute and painful 7-8/ out of 10. It is difficult to walk from strong abdominal pressure. Just lying left-sided on the bed and considering a flight to Miami.

I cannot lie here in pain for three more months like this. If I can stop the contractions/relax my uterus, then at least I can return to a somewhat normal life. My internet searches yield everything from calcium-channel blockers, magnesium sulfate, warm baths, herbs, to a glass of wine. Any input is greatly appreciated. Thanks.

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I'm afraid you need to consult your OB-GYN. We are unable to give medical advice here due to the TOS.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Did they do an FfN?

The standard of care at our hospital would be subcut terb, then home with PO terb (2.5mg q4-6h). Assuming a negative FfN and no cervical change, we probably wouldn't do more than that. The OB might also order regular U/S to check for funneling or cervical length changes.

If terb wasn't successful at keeping contractions at bay, our OBs might switch to nifedipine.

Assuming, though, that the FFN remains negative, and the UCs aren't causing cervical change, then they'd probably just say "Sorry you're uncomfortable, nothing we can do."

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I started frequent, non-painful contractions at around 28 weeks with my second child. OB did a FFN which was negative. Then placed me on Procardia for 7 days. I actually ended up with these contractions for the remainder of my pregnancy, until I delivered at 38 weeks. I was monitored 1-2 times weekly with NST's and that was it.

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I began preterm contractions at 12 wks and ended up on bedrest for the next 6 months with preg. number 2. We lived in Costa Rica at the time and already had a 12 month old baby. I also took medication to keep the contrations down. It was difficult and we fully expected to deliver a preterm baby. Had a great High Risk OB who made house calls. We had an emergency plan in place- and there was a great childrens hospital avai lable there should the baby come early. I made it till 38 wks!

Were living in Honduras when we got pregnant with number 3. Preterm labor began at 8 wks. It was very tough, and I began having trouble with low BP as well and living in a very hot and humid climate in a country with serious nation-wide electrical shortages. My high risk OB told us that if we had the means to go to the USA, he would advise that, because infants born prior to 37wks had a VERY high mortality rate in Honduras. We left for care in the USA when I got to 24wks, because at that time, that was the age in the US when they were able to keep premies alive. I made it to 37wks, and our dd is fine.

I kept hydrated, on bedrest, and took the meds (terbutaline) they perscribed. We made our decision based on the care available to me in terms of high risk OB care, and what the country offers in terms of NICU and premie specialists.

Good luck!

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Oh you poor girl! I can imagine how nervous you must feel being in a country where you are unsure of your healthcare. Visteril was given years ago and sometimes is still given by old docs here in the USA. I think if you continue to contract we all know that 24 weeks is way too early to be contracting so something needs to be done. I think having a 24 weeker in a country with substandard health care would be horrible. You should definately fly to the US and find out what is going on. The ffn stands for fetal fibronectin. Good luck to you! Please keep us updated!

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