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PubMed2000

Military duty: risk factor for preterm labor? A review.

The female military population represents a high-risk group for preterm labor and other adverse pregnancy outcomes. As the number of women entering the armed forces continues to increase, concerns regarding the effects of military service on pregnancy must persist. Although active duty females have access to prenatal care and maintain consistent follow-up, previous research has noted a 5-fold increase in preterm labor compared with civilian working women. Hospitalization and loss of work attributable to pregnancy complications directly affect productivity and mission accomplishment; therefore, it is crucial to identify those at risk to institute measures that will prevent such occurrences and decrease time away from work. This article provides a review of the existing literature concerning preterm labor in military women, comparisons with the civilian population, and recommendations for future research.

Absenteeism↗
PubMed1988

Amniotic fluid prostaglandin E2 in preterm labor.

These studies were designed to determine amniotic fluid concentrations of prostaglandin E2 (PGE) in women with preterm labor. Amniotic fluid was retrieved by transabdominal amniocentesis from 68 women with preterm labor (less than 37 weeks). Patients were divided into three groups according to the response to tocolysis and the presence or absence of an intraamniotic infection. Amniotic fluid concentrations of PGE2 were significantly greater in women with preterm labor and intraamniotic infection than in women without infection. Patients unresponsive to tocolysis without intraamniotic infection had a significantly greater concentration of PGE2 in amniotic fluid than those responsive to tocolysis.

Adult↗
PubMed2000

Maternal serum interleukin 1, 2, 6, 8 and interleukin-2 receptor levels in preterm labor and delivery.

OBJECTIVE: To determine the concentrations of maternal serum interleukins (ILs) 1, 2, 6, 8 and IL-2 receptors (IL-2R) in patients in their second and third trimesters of pregnancy and in preterm labor and delivery without evidence of chorioamnionitis. STUDY DESIGN: The study was conducted in La Paz Maternal Hospital, Madrid. Maternal serum IL concentrations were measured in 103 gravidas during preterm labor and delivery. The Mann-Whitney U test was used for analysis. RESULTS: Women in preterm labor and delivery had significantly higher median IL-2R concentration. Women who responded to tocolysis had significantly lower serum concentrations of IL-6. IL-2R and IL-6 serum concentrations predict delivery in 48 h and before 34 weeks gestation. CONCLUSIONS: Compared with non-laboring gravidas, those in idiopathic preterm labor or delivery had significantly higher concentrations of maternal serum IL-2R. Both IL-6 and IL-2R may predict failure of tocolysis. IL-2 does not seem to play an important role in pregnancy.

Biomarkers↗
PubMed2006

Antibiotic administration to patients with preterm labor and intact membranes: is there a beneficial effect in patients with endocervical inflammation?

OBJECTIVE: To determine whether broad-spectrum antibiotic administration to patients with preterm labor and intact membranes is associated with an improvement in neonatal and maternal outcomes, particularly in patients with microbial invasion of the amniotic cavity (MIAC) or endocervical inflammation (ECI). METHODS: A prospective clinical trial was conducted in which women in premature labor were alternately allocated to receive either antibiotics or placebo, and information about MIAC and ECI collected. Eighty-four pregnant women between 24 and 34 weeks of gestation with spontaneous preterm labor were enrolled. Exclusion criteria were cervical dilatation greater than 3 cm, clinical chorioamnionitis, abruption, rupture of membranes, vaginal bleeding, and several additional fetal and maternal conditions that may influence perinatal outcome. Amniocentesis was offered to all patients and the cervix and vagina were sampled for microbiological and cytological studies. Eligible patients were allocated to receive either clindamycin-gentamycin or placebo for 7 days. Corticosteroids and tocolysis with beta-adrenergic agents were used according to the standard management of our institution. MIAC was defined as the presence of a positive amniotic fluid culture obtained by trans-abdominal amniocentesis. ECI was diagnosed when a significant increase in the white blood cell count of the endocervical secretions was found. A composite neonatal morbidity/mortality outcome was created, including severe neonatal morbidity (respiratory distress syndrome, asphyxia, sepsis, pneumonia, intraventricular hemorrhage) and mortality. RESULTS: Thirty-nine women received antibiotics and 40 received placebo. The prevalence of ECI and MIAC in both groups was comparable (antibiotic group ECI 61.5% (24/39) and MIAC 20.5% (8/39); placebo group ECI 62.5% (25/40) and MIAC 20% (8/40); p > 0.05). Overall, there were no significant differences in maternal infections and composite neonatal outcomes between antibiotic and placebo groups. Women who received antibiotics had a lower rate of subsequent rupture of membranes compared to patients who received placebo (2.6% (1/39) vs. 25% (10/40), respectively; p = 0.007). A sub-analysis showed that among patients with ECI, antibiotic administration was associated with a lower rate of composite neonatal morbidity/mortality outcome compared to those who received placebo (4.2% (1/24) vs. 28% (7/25), respectively; p < 0.05). This association was also present in patients with ECI without MIAC (0% (0/16) vs. 27.8% (5/18); p < 0.05), but not in patients with ECI and MIAC (antibiotic group 12.5% (1/8) vs. placebo group 28.6% (2/7); p > 0.05). CONCLUSIONS: The combination of antibiotics used in this study did not improve maternal or perinatal outcome in patients with preterm labor and intact membranes. Further studies are required to determine if women with endocervicitis presenting with preterm labor and intact membranes may benefit from antibiotic administration.

Administration, Oral↗
PubMed1992

Urinary excretion of prostacyclin and thromboxane metabolites in threatened preterm labor: effect of indomethacin and nylidrin.

OBJECTIVE: We studied the role of smooth muscle-relaxing prostacyclin and its endogenous antagonist, thromboxane A2, in preterm labor by assessing the urinary output of the breakdown products of prostacyclin (6-keto-prostaglandin F1 alpha and 2,3-dinor-6-keto-prostaglandin F1 alpha) and those of thromboxane A2 (thromboxane B2, 2,3-dinor-thromboxane B2). STUDY DESIGN: Thirty-three women in preterm labor between 25 and 34 weeks of gestation were studied before, during, and after treatment with indomethacin (n = 16) or nylidrin (n = 17). Urinary prostanoid levels were determined by high-performance liquid chromatography followed by radioimmunoassay, and the excretion was expressed as nanograms of prostanoids per millimole of creatinine. Statistical analyses were done by paired and unpaired Student t test, by Spearman's correlation, and by Wilcoxon signed-rank test. RESULTS: Preterm labor was accompanied by a median 32% higher output of prostacyclin and thromboxane A2 metabolites as compared with those in 25 controls. At 8 hours after the start of treatment indomethacin induced maximal drops in 6-keto-prostaglandin F1 alpha (70%), in dinor-6-keto-prostaglandin F1 alpha (60%), in thromboxane B2 (85%), and in dinor-thromboxane B2 (95%) excretion. Within 1 week after the cessation of indomethacin, output of prostacyclin metabolites had recovered to pretreatment values, whereas output of thromboxane A2 metabolites was yet lower than the pretreatment value. Nylidrin induced no change in the output of prostacyclin and thromboxane A2 metabolites. CONCLUSION: Threatened preterm labor is associated with a rise in prostacyclin and thromboxane A2 synthesis. Indomethacin inhibits more thromboxane A2 than does prostacyclin synthesis. These findings may explain the fetal vascular changes during maternal indomethacin treatment.

6-Ketoprostaglandin F1 alpha↗
PubMed2006

Alterations in uterine sodium pump abundance may contribute to the onset and progression of term and preterm labor in mice.

OBJECTIVE: Other investigators have shown that reductions in active sodium pump units increase uterine contractility. Therefore, our goal was to determine whether uterine sodium pump abundance is decreased in mouse models of term and preterm labor. STUDY DESIGN: Mice were studied during the final one-third of pregnancy. Other pregnant mice had preterm labor induced with lipopolysaccharide and were studied at timed intervals thereafter. Uterine sodium pump alpha3-isoform messenger RNA and protein were measured. Data were analyzed by analysis of variance. RESULTS: Uterine sodium pump alpha3-isoform messenger RNA fell significantly from day 14 to day 18 and remained low on the day of birth. Uterine sodium pump alpha3-isoform protein levels decreased significantly also. In lipopolysaccharide-induced preterm labor, uterine sodium pump alpha3-isoform protein, but not messenger RNA, decreased significantly. CONCLUSION: Sodium pump alpha3-isoform protein levels decreased in uterus before term labor and lipopolysaccharide-induced preterm labor. These findings are similar to those in humans, which suggests that this mouse model may be useful in the study of the sodium pump in human pregnancy. Reductions in sodium pump number can increase uterine contractile force and may contribute to labor.

Animals↗
PubMed2006

A randomized controlled trial of adjunctive erythromycin in women with idiopathic preterm labor.

OBJECTIVE: Our purpose was to determine the effects of erythromycin among hospitalized women with idiopathic preterm labor who were treated with tocolytics. METHODS: This prospective randomized trial was conducted in patients with preterm labor of no clinically identifiable cause between 26 and 34 weeks of gestation, who were receiving magnesium sulfate. A total of 136 patients were screened. Of these, 80 eligible, consenting patients were randomized to receive either 400 mg erythromycin or placebo orally every 6 hours for 10 days. Necessary statistical comparisons were preformed using unpaired two-tailed Student's t-test and Chi-square analysis. RESULTS: In comparing the 38 erythromycin and 42 placebo patients there was improvement in the treatment-to-delivery interval (33.33 +/- 18.36 versus 26.88 +/- 13.9 days, respectively), mean gestational age at delivery (36.11 +/- 2.33 versus 34.36 +/- 2.33 weeks, respectively), mean birth weight (2722.31 +/- 511.65 versus 2419.41 +/- 513.54 g, respectively), and reduced neonatal admission to NICU (36.8% versus 60.19%) in the erythromycin group. CONCLUSION: In patients with idiopathic preterm labor the adjunctive use of erythromycin therapy appeared safe and well tolerated and resulted in a statistically significant delay from admission to delivery and improved gestational age at delivery, mean birth weight and neonatal outcome.

Adult↗
PubMed2001

Methods and devices for the management of term and preterm labor.

In this review, we outline studies showing that the uterus (myometrium) and cervix pass through a conditioning step in preparation for labor. This step is not easily identifiable with present methods designed to assess the uterus or cervix. In the uterus, this seemingly irreversible step consists of changes in the electrical properties that make muscle more excitable and responsive and produce forceful contractions. In the cervix, the step consists of softening of the connective tissue components. Progesterone and nitric oxide appear to have important roles in these processes. The progress of labor can be assessed noninvasively using electromyographic (EMG) signals from the uterus (the driving force for contractility) recorded from the abdominal surface. Uterine EMG bursts detected in this manner characterize uterine contractile events during human and animal pregnancy. A low uterine EMG activity, measured transabdominally throughout most of pregnancy, rises dramatically during labor. EMG activity also increases substantially during preterm labor in humans and rats and may be predictive of preterm labor. A quantitative method for assessing the cervix is also described. A collascope estimates cervical collagen content from a fluorescent signal generated when collagen crosslinks are illuminated with an excitation light of about 340 nm. The system has proved useful in rats and humans at various stages of pregnancy and indicates that cervical softening occurs progressively in the last one-third of pregnancy. In rats, collascope readings correlate with resistance measurements made in the isolated cervix, which may help to assess cervical function during pregnancy and indicate controls and treatments.

Delivery, Obstetric↗
PubMed1997

Nifedipine and ritodrine in the management of preterm labor: a randomized multicenter trial.

OBJECTIVE: To compare the efficacy of nifedipine with ritodrine in the management of preterm labor. METHODS: One hundred eighty-five singleton pregnancies with preterm labor were assigned randomly to either ritodrine intravenously (n = 90) or nifedipine orally (n = 95). The principal outcome assessed was delay of delivery. RESULTS: Ritodrine was discontinued in 12 patients because of severe maternal side effects, and their results were excluded from further analysis. More women in the ritodrine group delivered within 24 hours (22 versus 11, P = .006), within 48 hours (29 versus 21, P = .03), within 1 week (45 versus 36, P = .009), and within 2 weeks (52 versus 43, P = .005) compared with those receiving nifedipine. There were significantly fewer maternal side effects in the nifedipine group. Apgar scores and umbilical artery and vein pHs were similar in both groups. The number of admissions to the neonatal intensive care unit (NICU) in the nifedipine group was significantly lower than in the ritodrine group (68.4 versus 82.1%, P = .04). CONCLUSION: Nifedipine in comparison with ritodrine in the management of preterm labor is significantly associated with a longer postponement of deliver, fewer maternal side effects, and fewer admissions to the NICU.

Administration, Oral↗
PubMed2003

Antimicrobial peptides in amniotic fluid: defensins, calprotectin and bacterial/permeability-increasing protein in patients with microbial invasion of the amniotic cavity, intra-amniotic inflammation, preterm labor and premature rupture of membranes.

OBJECTIVE: Neutrophil defensins (HNP 1-3), bactericidal/permeability-increasing protein (BPI) and calprotectin (MRP8/14) are antimicrobial peptides stored in leukocytes that act as effector molecules of the innate immune response. The purpose of this study was to determine whether parturition, premature rupture of the membranes (PROM) and microbial invasion of the amniotic cavity (MIAC) are associated with changes in amniotic fluid concentrations of these antimicrobial peptides. STUDY DESIGN: Amniotic fluid was retrieved by amniocentesis from 333 patients in the following groups: group 1, mid-trimester with a subsequent normal pregnancy outcome (n = 84); group 2, preterm labor and intact membranes without MIAC who delivered at term (n = 36), or prematurely (n = 52) and preterm labor with MIAC (n = 26); group 3, preterm PROM with (n = 26) and without (n = 26) MIAC; and group 4, term with intact membranes in the absence of MIAC, in labor (n = 52) and not in labor (n = 31). The concentrations of HNP 1-3, BPI and calprotectin in amniotic fluid were determined by specific and sensitive immunoassays. Placentae of patients in both preterm labor with intact membranes and preterm PROM groups who delivered within 72 h of amniocentesis were examined. Non-parametric statistics, receiver-operating characteristic (ROC) curves and Cox regression models were used for analysis. A p value of < 0.05 was considered statistically significant. RESULTS: Intra-amniotic infection was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin in both women with preterm labor and intact membranes, and women with preterm PROM. Preterm PROM was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Preterm parturition was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin, while parturition at term was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3. Among patients with preterm labor and intact membranes, elevation of amniotic fluid HNP 1-3, BPI and calprotectin concentrations was associated with intra-amniotic inflammation, histological chorioamnionitis and a shorter interval to delivery. CONCLUSION: MIAC, preterm parturition and preterm PROM are associated with increased amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Moreover, elevated amniotic fluid concentrations of BPI, immunoreactive HNP 1-3 and calprotectin are associated with intra-amniotic inflammation, histological chorioamnionitis and shorter amniocentesis-to-delivery interval in patients presenting with preterm labor with intact membranes.

Amnion↗
PubMed1998

Corticotropin-releasing hormone: a biochemical predictor of preterm delivery in a pilot randomized trial of the treatment of preterm labor.

OBJECTIVE: We assessed the ability of maternal plasma corticotropin-releasing hormone measurements to predict preterm delivery in the setting of a pilot study comparing transdermal glyceryl trinitrate with standard beta-mimetic therapy for preterm labor and to determine the effect of these tocolytics on maternal plasma corticotropin-releasing hormone concentrations. STUDY DESIGN: Twenty-six consecutive patients with preterm labor were randomized to tocolytic treatment with transdermal glyceryl trinitrate (n=13) or intravenous albuterol (n=13). RESULTS: Plasma corticotropin-releasing hormone immunoreactivity levels were higher in women who were delivered within 7 days (41.4+/-13.5 pmol/L) than in those continuing to term (14.2+/-2.4 pmol/L, p=0.011) and were not altered by treatment. Two women in each of the treatment groups delivered within 7 days of the initiation of treatment, two women in the glyceryl trinitrate group were changed to albuterol because of persistence of contractions. Glyceryl trinitrate treatment was associated with significantly fewer maternal side effects. Neither treatment altered umbilical artery Doppler ultrasonographic findings. CONCLUSION: Transdermal glyceryl trinitrate is better tolerated than intravenous albuterol but may be no more efficacious than albuterol for the treatment of preterm labor. Biologic markers such as plasma corticotropin-releasing hormone levels may be an important method of identifying women at high risk of preterm delivery.

Administration, Cutaneous↗
PubMed1995

Outpatient oral sulindac to prevent recurrence of preterm labor.

OBJECTIVE: To assess the efficacy and safety of oral sulindac in preventing the recurrence of preterm labor. METHODS: This was a randomized, double-blind, placebo-controlled study of patients between 24-34 weeks' gestation with preterm labor treated with intravenous magnesium sulfate. After successful tocolysis, patients were randomized by the pharmacy to receive either oral sulindac (200 mg) or placebo (once orally every 12 hours) for 7 days. RESULTS: Sixty-nine patients were enrolled (34 in the sulindac group, 35 controls). No significant differences were found with respect to time gained in utero (40 +/- 4.4 versus 31 +/- 3.4 days, P = .1), delivery at more than 35 weeks' gestation (20 versus 18, P = .70), recurrent preterm labor (11 versus 13, P = .88), birth weight (2528 +/- 646 versus 2459 +/- 707 g, P = .68), or time spent in the neonatal intensive care unit (4.2 +/- 12.9 versus 5.7 +/- 13.5 days, P = .63) for the sulindac and control groups, respectively. However, in women who failed therapy (ie, those who delivered before 37 weeks' gestation or required readmission for tocolysis), there was a significantly longer interval between the start of therapy and failure in the sulindac group (25.9 +/- 3.4 days, n = 26) than in the control group (15.2 +/- 2.8 days, n = 25; P < .05). CONCLUSION: The use of oral sulindac for 1 week after successful parenteral tocolysis failed to reduce the overall rate of preterm birth. In women who delivered prematurely or required readmission for tocolysis, oral sulindac significantly prolonged the interval from the start of therapy until delivery or readmission. Moreover, this benefit was achieved without observable adverse effects on the fetus.

Administration, Oral↗
PubMed1990

Antepartum uterine activity characteristics differentiating true from threatened preterm labor.

Daily antepartum nursing contact and ambulatory uterine activity monitoring have been used for the early detection of preterm labor. However, it may be difficult to separate true labor from false labor. In this study, the uterine activity records of 110 women at risk for preterm birth with excessive contraction frequencies were evaluated by blinded reviewers. Maternal symptomatology and uterine activity characteristics such as low-amplitude high-frequency contractility, contraction amplitude, contraction duration, contraction interval, and contraction rhythmicity were assessed for their ability to differentiate true from threatened preterm labor. Neither maternal symptomatology nor any uterine activity characteristic other than contraction frequency could differentiate true from threatened preterm labor. Antepartum uterine activity monitoring should continue to rely on contraction frequency to identify the woman at risk for premature labor.

Adult↗
PubMed1989

A national survey on preterm labor.

A national survey was conducted to examine the American obstetricians' approach to management of preterm labor. Multiple-choice questionnaires were mailed to all current members of the Society of Perinatal Obstetricians and 750 randomly selected diplomates of the American College of Obstetricians and Gynecologists. Respondents included 249 members of the Society of Perinatal Obstetricians and 441 fellows of the American College of Obstetricians and Gynecologists. Analysis of the replies reflects wide variations among American obstetricians' criteria to diagnose preterm labor, choice of tocolytic agent, use of amniocentesis, and use of corticosteroids. Significant differences were found between the two groups in many aspects of diagnosis and management of preterm labor. However, the replies reflect a high degree of awareness of and many instances of first hand experience with severe beta-adrenergic therapy complications, including maternal death. These findings emphasize the need for caution in selection of patients for beta-adrenergic tocolytic therapy and judicious use of these agents.

Adrenal Cortex Hormones↗
PubMed1996

Elevated placental cytokine release, a process associated with preterm labor in the absence of intrauterine infection.

OBJECTIVE: To investigate the role of cytokines in normal term and preterm labor in the absence of intrauterine infection. METHODS: Cytokine (interleukin [IL]-1 beta, IL-6 and tumor necrosis factor-alpha [TNF-alpha]) release was estimated from placental and decidual cell cultures from 22 nonlaboring women at term with cesarean deliveries, 18 women with spontaneous labor at term, and 21 women with preterm labor (19-36 weeks gestation) who delivered vaginally or by cesarean, according to gestational age. Eight of 21 women delivering preterm had clinical evidence of intrauterine infection, and 13 were not infected. RESULTS: Placental cell cultures obtained from women with spontaneous term labor released significantly larger amounts of cytokines (median: IL-1 beta 6450 pg/mL, IL-6 1821 ng/mL, and TNF-alpha 13,506 pg/mL) compared with placental cell cultures from nonlaboring women at term (median: IL-1 beta 2602 pg/mL, IL-6 993 ng/mL, TNF-alpha 3475 pg/mL; P < .02). Placental cells from women delivering preterm with intrauterine infection did not produce significantly different amounts of cytokines (median: IL-1 beta 3929 pg/mL, IL-6 1084 ng/mL, TNF-alpha 2847 pg/mL) when compared with those of nonlaboring women at term, whereas placental cells from uninfected women delivering preterm produced significantly larger amounts of cytokines (median: IL-1 beta 22,903 pg/mL, IL-6 1899 ng/mL, TNF-alpha 15,005 pg/mL; P < .01) than cells from nonlaboring women at term. Cytokine release from decidual cell cultures was similar in all groups tested. CONCLUSION: In the absence of intrauterine infection, preterm labor was associated with elevated placental cytokine release.

Adult↗
PubMed1987

Antibacterial activity of amniotic fluid in the early third trimester. Its association with preterm labor and delivery.

The purpose of this study was to determine the bacterial growth inhibitory property of amniotic fluid (AF) from patients in the early third trimester and to examine its relationship to preterm labor and delivery. A total of 38 AF samples from patients between 27 and 35 weeks gestation with intact membranes were studied. Antibacterial activity was tested against Escherichia coli, Staphylococcus aureus, and Bacteroides fragilis. Fifteen fluids were from patients in preterm labor who delivered near term after successful inhibition of labor. Five of these fluids (33%) were inhibitory to E. coli, five (33%) to S. aureus, and 11 (73%) to B. fragilis. Nine fluids were from patients who failed inhibition of labor and delivered preterm; none of these were inhibitory to E. coli, two (22%) to S. aureus, and only one (11%) to B. fragilis (P less than 0.005). Two of the nine fluids from patients who failed inhibition of labor also yielded fusobacteria. The remaining 14 fluids were obtained from patients without preterm labor and exhibited antibacterial activity similar to that from patients with successful labor inhibition. Results suggest a relationship between the absence of AF antibacterial activity against B. fragilis and preterm delivery in patients with preterm labor and intact membranes.

Amniocentesis↗
PubMed1987

The presence or absence of fetal breathing movements as a predictor of outcome in preterm labor.

The presence or absence of fetal breathing movements may be helpful in differentiating between true and false preterm labor. We attempted to demonstrate the clinical utility of this simple ultrasonic observation in predicting short-term delivery outcome during suspected preterm labor. A total of 50 pregnancies between 26 and 34 weeks' gestation with presumed preterm labor were observed in a prospective manner. During 20 minutes of observation with real-time ultrasound at the time of admission, fetal breathing movements were observed in 33 patients and considered absent in the remaining 17 patients. In those pregnancies with absent fetal breathing movements, true labor with subsequent delivery occurred in 16 patients. Of the 33 pregnancies with fetal breathing movements present, 29 continued for greater than 48 hours. It appears that the absence of fetal breathing movement is a reliable indicator of imminent preterm delivery, irrespective of fetal membrane status (p less than 0.0001). The observed mean sensitivity and specificity of this phenomenon in predicting short-term delivery outcome are 96.6% +/- 3.3% (mean +/- SD) and 80.0% +/- 8.9%, respectively. A multivariant statistical model based on the frequency of contractions, white blood cell counts, initial cervical examination results, and premature rupture of membranes could successfully predict delivery outcome in 40% to 75% of cases. The addition of fetal breathing movement analysis to the model allowed for the correct prediction of outcome in 90% of the cases.

Delivery, Obstetric↗
PubMedDate not supplied

Living with the threat of preterm labor: Women's work of keeping the baby in.

OBJECTIVE: To explore the social organization of women's preterm labor experiences. DESIGN: Institutional ethnography investigated how the woman's experience is socially organized and for patterns of how something is organized to recur. PARTICIPANTS/SETTING: Eight women who experienced preterm labor while living in one city in Western Canada volunteered to participate. DATA ANALYSIS: Institutional ethnographic methodology guided the analysis of audiotaped transcribed interviews to understand the work these women do and the complexities of their everyday lives. RESULTS: Women spoke about their fear of going home and feeling alone with the responsibility for their work of "keeping the baby in." Overall, preterm labor was experienced as a profound sense of personal responsibility for preventing preterm birth and was practiced as being "careful." CONCLUSIONS: The assumption that the family is privately responsible for care work in the home results in the lack of assessment of resources for managing the medical plan on discharge and the lack of resources available or offered to assist families. The work of keeping the baby in conflicts with family care work responsibilities and can cause significant hardships for some women and families.

Adaptation, Psychological↗