Management Dilemmas in Threatened Preterm Labor (TPTL) and its Impact: A Mini Review

Abstract

Prematurity is a primary cause of neonatal mortality worldwide. The survivors also suffer long term complications and significant permanent neurodevelopmental disability. It contributes to about 70% of neonatal deaths and 36% of infant mortality. Neonatal mortality can be reduced by appropriate diagnosis, administration of corticosteroids, judiciary use of tocolytics and timely transfer to a centre with neonatal intensive care unit. Only about 10%-30% of cases with symptoms of preterm labor proceed to preterm delivery. Hence, it is necessary to differentiate between true preterm labor and threatened preterm labor (TPTL). The latter is diagnosed with onset of regular uterine contractions (at least one in ten minutes) with minimal or no cervical changes and intact membranes. There is no exact definition of TPTL and it varies between various institutions and countries. Over the last decade, there has been a tremendous development to aid in the prediction of preterm labor. Recently, transvaginal cervical length measurement and presence of fetal fibronectin (ffn) and/or phosphorylated insulin growth factor binding protein - 1 (phIGFBP - 1) in cervical fluid can be used to delineate between true and threatened preterm labor.