TheAnswerPage/Obstetrics & Gynecology Wednesday 03/10/2010 This week: Preterm labor

A 36-year-old G₇P₁₂₃₃ presents at 32 weeks' gestation complaining of increasing abdominal pain and diminished fetal movement for 12 hours. Bimanual examination shows her cervix to be 4 cm dilated and 90% effaced. Fetal cardiotocography shows evidence of uterine contractions every three minutes. Fetal heart rate tracing is reactive with a baseline of 140 bpm and no decelerations. A diagnosis of preterm labor is made.

1. You are considering administering a tocolytic agent. Are there any contraindications to tocolysis?
2. Should you recommend strict bedrest and aggressive intravenous hydration?
3. Is antibiotic administration recommended? If so, what is the indication and for how long should treatment be continued?

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