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Objective To examine the knowledge that healthy pregnant women have of appropriate actions to take in response to hypothetical symptoms of preterm labor. Design This was a descriptive, correlational study using a convenience sample. Setting Subjects were recruited from the private practices of obstetricians and nurse-midwives. Participants Three hundred twenty pregnant women who were between 20 and 32 weeks gestation were asked to complete a 17-item demographic information sheet and an 18-item Health Pregnancy Questionnaire while waiting for prenatal visits. Questionnaires from 269 women were appropriate for analysis. Results Most respondents could select appropriate action responses to items that identified obvious symptoms of being in preterm labor. In response to three questions that posed hypothetical preterm labor symptoms that were more subtle or were similar to normally occurring discomforts of pregnancy, between 26% and 35% of the women selected a choice that would have delayed entry into care. With a 95% confidence interval, significant positive relationships were found between selecting best responses and having experienced a previous preterm labor and maternal age. Conclusion This study supports the need for all pregnant women to receive information on identification of preterm labor symptoms and appropriate actions to take with regard to these symptoms.

Objective The purpose of this study was to compare strategies of corticosteroid administration for the prevention of neonatal morbidity and death. Study design A Markov decision model compared 3 strategies of antepartum corticosteroid administration: (1) to all pregnant women (universal), (2) to all pregnant women with a previous preterm delivery (high risk), and (3) to women who had preterm labor symptoms that placed them at risk for delivery within 7 days (current). A second model with addition of a “rescue” arm to capture women who remained undelivered was also created. Results Compared with the current strategy, the universal strategy would result in roughly 1000 fewer cases of respiratory distress syndrome and >3 million more women would receive corticosteroids annually. The addition of a rescue arm further reduces morbidity and mortality rates. Conclusion A universal strategy of corticosteroid administration confers potential benefit for the prevention neonatal morbidity or death over the current strategy but requires that a large number of women be treated.

Objective: To model cost implications of the fetal fibronectin (fFN) assay in management of patients with symptoms of preterm labor based on data from a previously published multicenter trial. Study design: Data from a trial of fFN in 763 patients with symptoms of preterm birth was used to create a decision analytic model. Standard management in the trial was compared with a theoretic management plan using fFN results to guide decisions regarding hospitalization and use of bedrest. Average costs and durations of antepartum and delivery hospitalizations for patients with preterm labor were obtained from a data set of 404,466 patients delivered in California in 1993. Average bedrest costs were obtained using data from the US Bureau of Labor Statistics ($89 per day). A cost savings of $3,000 from the use of betamethasone prior to 34 weeks was assumed based on estimates from the NIH consensus conference. All patients were treated equally until fFN results were obtained. All fFN positive patients were admitted, given steroids, and discharged after an average of 2.5 days of bedrest. Results: Under baseline assumptions, theoretic management using fFN cost $3,900 per patient vs estimates of $4,820 in the trial. This resulted in savings of $919 per patient, which was robust under sensitivity analysis of all costs in the model. Conclusions: Addition of fFN management of threatened preterm labor has theoretic cost advantages when compared to existing patterns of clinical management.

C-reactive protein has been used to identify patients at high risk for infectious morbidity with preterm labor or preterm rupture of membranes. In this article we report on 104 patients with preterm labor symptoms (n = 45) or preterm rupture of the membranes (n = 59) and serial evaluations of C-reactive protein measured by latex agglutination and laser nephelometry. The simple, inexpensive latex method appears comparable to the laser method in predicting infectious morbidity and can be used clinically. Elevated C-reactive protein values before delivery predict infectious morbidity in only 8% to 29% of patients, and up to 18% of patients with serious infections may be misdiagnosed as having normal C-reactive protein values before delivery.