OB-GYN-L Messages for October, 1995: Re: tocolysis vrs irritable uterus

Re: tocolysis vrs irritable uterus

From: MS GAIL M HART

YTDP43A@prodigy.com

Fri Oct 27 21:05:39 1995

RE David Nagey<<< the cost will be even lower if < you don't treat < the condition at all, and instead await cervical change?

I agree, however, in a woman contracting one needs to see her in order to assess for cervical change. To me this means the patient must be evaluated in L and D if its in the middle of the night. Herein lies the dilemma. Should we use an inexpensive medication, ie., po terb, prophylactically to prevent an expensive evaluation only hospital visit which is likely to yield an unchanged cervix,<<<<<<<MNudel

May I share our general protocol when the preterm woman calls us with contractions? "Usually" this is simply a matter of evaluation and reasurance --- the difficulty (as we all know) is weeding out the woman with true preterm labor from the majority who simply have an irritable uterus (for want of a better term). Instead of sending to L & D for evaluation, we can usualy spend time on the phone (If this is not "obvious labor") --- --- I ask the woman to get a LARGE glass of water, sit down somewhere comfortable, have someone start the bathtub filling for her, and drink the glass of water while we visit on the phone for a bit. If the woman has contractions I time them, we ask for other signs, symptoms of labor, how low the baby feels, cervical mucus or discharge. We often find that the "frequent, strong contractions" are perhaps only 10 seconds or so, and the woman can talk well through them. (this is reasuring in itself --and reasurance (and evaluation) is what most women need at this point). If at the end of our long talk this still doesn't seem to be 'real" labor -- I ask the mom to drink another glass of water and take a long warm bath; to call me if the contractions don't slow down and fizzle-out with some relaxation in warm water. (and to call regardless in about a half hour) Almost always the bath slows or stops all contractions - perhaps the drinking water helps too. We assume this is just another bout of "false" labor or "prelabor" if everything quiets down;.......... If not -- if anything looks suspiciously real -- I'll meet her for evaluation at L & D.... Assuming things DO slow down, we advise "rest" for the next day or so, and close phone contact.

The time spent "watching" over the phone is pretty short, an hour usualy tells us if anything is truly happening. Often, we find mom has just had a busy and stressful day, perhaps has not eaten or taken liquids for several hours -- she's tired, her uterus is too, she's feeling things she probably wouldn't if she were at her best. Sometimes just having someone to talk to slows the contractions down! (They probably would have anyway.. but it's less interventive than prophylactic terbutaline<G> or a frantic run to L & D just for IV fluids and reasurance).

I think we need to make women aware that preterm contractions are to be expected from time to time -- the old braxton-Hicks story -- and try to help them recognize "true" labor pattern contractions from the "normal" busy-ness of the uterus.... . Many women have become so alarmed at the idea of preterm contractions that they percieve every little twinge and tweaking as signs of labor. (and are pleased to phone us at 3 AM)!

Some midwives recommend herbal teas etc -- I don't know of any research ever done on their effectiveness. I'm inclined to think that the emotional relaxation, and perhaps increased liquid may be a help..... Gail Hart LDEM Oregon

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