Suspected Preterm Labor
Regular contractions before 37 weeks with cervical change
All Pathways
Obstetrics & GynecologyManagement
Preterm Labor Management (ACOG 2016)
Preterm Labor Management (ACOG 2016): Suspected Preterm Labor → Initial Assessment → True Preterm Labor? → Not True Preterm Labor.
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Action Initial Assessment
Confirm gestational age and evaluate
- Confirm gestational age (ultrasound dating)
- Sterile speculum exam (r/o ROM)
- Digital cervical exam if membranes intact
- Fetal fibronectin (if 24-34 weeks, <3cm)
- Cervical length by TVUS
- Fetal monitoring and vitals
03Decision True Preterm Labor?
Contractions + cervical change
- Regular contractions q10min or less
- Cervical dilation ≥2cm OR
- Cervical change on serial exams OR
- Cervical length <20mm on TVUS
- Positive fFN increases risk
04Outcome Not True Preterm Labor
Observation and discharge criteria met
- Contractions resolve
- No cervical change
- Negative fFN and CL >30mm: low risk
- Discharge with preterm labor precautions
- Follow-up in 1-2 weeks
05Decision Gestational Age
Management varies by GA
06Action <23 weeks (Previable)
Limited intervention options
- Counsel on prognosis
- Comfort care vs. intervention
- No tocolysis or steroids indicated
- Palliative care consultation
- Shared decision-making with family
07Action 23-25+6 weeks (Periviable)
Shared decision-making for intervention
- Neonatology consultation essential
- Steroids if intervention desired
- Consider MgSO4 for neuroprotection if ≥24 weeks
- Tocolysis if intervention pursued
- Transfer to Level III/IV NICU
08Action Antenatal Corticosteroids
To accelerate fetal lung maturity
- Betamethasone 12mg IM x 2 doses, 24h apart
- OR Dexamethasone 6mg IM x 4 doses, 12h apart
- Optimal benefit 24h to 7 days after completion
- Rescue course: consider if >14 days and <34 weeks
- Late preterm (34-36+6): consider single course
09Action Tocolysis
Short-term delay for steroids and transfer
- FIRST LINE: Nifedipine 20mg PO, then 10-20mg q4-6h
- OR Indomethacin 50mg load, 25mg q6h (if <32 weeks, <48h)
- MgSO4 not preferred for tocolysis (for neuroprotection)
- Terbutaline: avoid if possible (cardiac risk)
- GOAL: 48h delay for steroids, NOT long-term
- Contraindications: chorioamnionitis, fetal distress
10Decision Delivery Occurring?
Despite tocolysis, labor may progress
11Outcome Prepare for Preterm Delivery
Optimize neonatal outcomes
- Neonatal team at delivery
- GBS prophylaxis if indicated
- Delayed cord clamping if stable
- Immediate newborn care protocols
- Document steroid timing
12Outcome Labor Stabilized
Continue observation
- Complete steroid course
- Discontinue tocolysis after 48h
- May discharge if stable
- Progesterone consideration
- Follow-up for cervical length
13Action MgSO4 for Neuroprotection
If <32 weeks and delivery imminent
- Loading: 4-6g IV over 20-30 min
- Maintenance: 1-2g/hour
- Continue until delivery or up to 24h
- Stop if delivery not imminent
- Reduces cerebral palsy risk ~40%
- Path rejoins step 10Shared downstream outcome
14Action 24-33+6 weeks
Full intervention indicated
- Antenatal corticosteroids
- Tocolysis to achieve steroids
- MgSO4 neuroprotection if <32 weeks
- GBS screening and prophylaxis
- Transfer if needed
- Path rejoins step 08Shared downstream outcome
Guideline Source
ACOG Practice Bulletin No. 171: Management of Preterm Labor
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Tocolysis delays delivery <48h - not long-term
- Does not address PPROM (separate algorithm)
- Cervical length thresholds may vary by institution
Applicable Regions
USEUGlobal
Version 1Next review: 2027-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Preterm Labor Management (ACOG 2016)?
The Preterm Labor Management (ACOG 2016) is a management clinical algorithm for Obstetrics & Gynecology. It provides a structured decision tree to guide clinical decision-making, based on ACOG Practice Bulletin No. 171: Management of Preterm Labor.
What guideline is the Preterm Labor Management (ACOG 2016) based on?
This algorithm is based on ACOG Practice Bulletin No. 171: Management of Preterm Labor (DOI: 10.1097/AOG.0000000000001711).
What are the limitations of the Preterm Labor Management (ACOG 2016)?
Known limitations include: Tocolysis delays delivery <48h - not long-term; Does not address PPROM (separate algorithm); Cervical length thresholds may vary by institution. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Preterm Labor Management (ACOG 2016) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free