Pregnancy Prolongation in Women With Preterm Cervical Dilatation Using Outpatient Preterm Labor Services

Abstract

It is generally accepted that tocolytic therapy becomes less effective in preventing preterm labor (PTL) as cervical dilatation progresses. This cohort study sought to determine the impact of cervical dilatation on pregnancy outcomes in 1435 women with high-risk pregnancies who were hospitalized because of increased uterine activity or persistent signs and symptoms of PTL. Subsequently, they were offered outpatient perinatal services. All had singleton gestations and cervical dilatation of 2 cm or more with intact membranes. They ranged from 22 to 35 weeks gestation when evaluated in the hospital, averaging 32.4 weeks. Participants had a total of 1474 episodes of PTL. Close to 40% had a history of previous preterm delivery. Gestational age at the time of hospitalization averaged 29 weeks, and the mean cervical dilatation was 2.6 cm. After hospitalization, the women gained a mean of 26 days before delivery. More than 85% of women resumed outpatient services, which nearly always emphasized maintenance tocolysis. When cervical dilatation was 3 cm or more, women were more likely to deliver before discharge. Approximately 15% of the group delivered within 1 week of assessment and 2.2% delivered on the first day in the hospital. In women discharged to resume home-care services, labor was deferred for 28 days on average, compared with 16.5 days for those who remained in the hospital. There were no maternal deaths and no serious maternal morbidity. These findings indicate that even women with advanced cervical dilatation are able to gain significant gestational time when evaluated in the hospital and offered outpatient PTL services.