Screening for Preterm Labor and Delivery

The purpose of screening is early diagnosis and treatment. Screening tests are given to people who do not have current symptoms, but who may be at high risk for certain diseases or conditions.

All pregnant women are screened for factors that may increase their risk of preterm labor. For women at low risk of preterm labor, there are no recommendations for further screening.

The benefit of screening high-risk women for preterm labor is controversial. Some methods of screening for preterm labor that may be used to screen high-risk women include:

Risk Factor Assessment

A list of risk factors can be checked at the first prenatal visit and later in pregnancy. A risk score can be determined for preterm delivery.

In order for risk identification to be helpful, it must be combined with a program to modify any risk factors that can be modified. These programs are usually community-based. Examples include the Alabama Preterm Birth Prevention Project, the Better Birth Outcomes trials, and other community-based initiatives.

Fetal Fibronectin

During a pelvic exam, your doctor may swab your cervix or vagina to test for fetal fibronectin (fFN). fFN acts as a glue to attach the amniotic sac to the lining of the uterus. It is normal for fFN to be in cervical secretions for the first 22 weeks of pregnancy. However, if fFN is present in the outer cervix beyond weeks 22-34, this glue may be breaking down earlier than it should. fFN may be a sign of impending preterm labor.

The presence of fFN (positive test result) is not a good predictor of whether you are at risk of preterm birth. However, the absence of fFN (negative test result) is a good predictor that you are not at risk of a preterm birth at this time. Your pregnancy is likely to continue for at least another 2 weeks.

Cervical Length    TOP

At the first prenatal visit, your doctor may measure your cervix using an ultrasound. During pregnancy, your cervix is monitored for changes. If your cervix is getting shorter, that means it is beginning to efface. This places you at higher risk for preterm delivery.

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References:

American College of Obstetricians and Gynecologists, Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 127: Management of preterm labor. Obstet Gynecol. 2012;119(6):1308-1317.
Goldenberg RL, Davis RO, Copper RL, Corliss DK, Andrews JB, Carpenter AH. The Alabama preterm birth prevention project. Obstet Gynecol. 1990;75(6):933-939.
Premature labor. American Pregnancy Association website. Available at:
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Updated March 10, 2017. Accessed March 8, 2018.
Preterm labor. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115273/Preterm-labor. Updated January 2, 2018. Accessed March 7, 2018.
Preterm (premature) labor and birth. The American College of Obstetricians and Gynecologists website. Available at:
...(Click grey area to select URL)
Updated November 2016. Accessed March 8, 2018.
Last reviewed March 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG
Last Updated: 3/15/2015

 

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