Frequency of uterine contractions and the risk of spontaneous preterm delivery
Open accessAbstract
BACKGROUND: The measurement of the frequency of uterine contractions has not been useful for reducing the rate of preterm delivery in randomized trials. Nonetheless, ambulatory monitoring of contractions continues to be used in clinical practice. METHODS: We assessed the frequency of uterine contractions as a predictor of the risk of spontaneous preterm delivery before 35 weeks of gestation. We enrolled women with singleton pregnancies between 22 and 24 weeks of gestation. The women used a contraction monitor at home to record contraction frequency twice daily on 2 or more days per week from enrollment to delivery or 37 weeks of gestation. RESULTS: We obtained 34,908 hours of successful monitoring recordings from 306 women. Although more contractions were recorded from women who delivered before 35 weeks than from women who delivered at 35 weeks or later, we could identify no threshold frequency that effectively identified women who delivered preterm infants. The sensitivity and positive predictive value of a maximal hourly frequency of contractions of four or more between 4 p.m. and 3:59 a.m. were 9 percent and 25 percent, respectively, at 22 to 24 weeks and 28 percent and 23 percent at 27 to 28 weeks. Other proposed screening tests, such as digital and ultrasound evaluations of the cervix and assays for fetal fibronectin in cervicovaginal secretions, also had low sensitivity and positive predictive value for preterm labor. CONCLUSIONS: Although the likelihood of preterm delivery increases with an increased frequency of uterine contractions, measurement of this frequency is not clinically useful for predicting preterm delivery.
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Uterine contraction frequency is associated with preterm birth, but contractions do not predict preterm birth well in singletons because of wide variation in normal pregnancy and large overlap between women who do and do not deliver preterm.
“Several studies have shown an association between uterine contraction frequency and preterm birth;117, 118, 119 however, uterine contractions do not predict preterm birth well in singletons because of the wide variation in frequency in normal pregnancy and the large overlap in frequency between women who do and do not deliver preterm.119”
From Epidemiology and causes of preterm birth (2008) · cites this paper as [119]
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- Authors
- Iams, J. D., Newman, R. B., Thom, E. A., Goldenberg, R. L., Mueller-Heubach, E., Moawad, A., Sibai, B. M., Caritis, S. N., Miodovnik, M., Paul, R. H., Dombrowski, M. P., Thurnau, G., & McNellis, D.
- Affiliations
- The Ohio State University (US)
- Medical University of South Carolina (US)
- George Washington University (US)
- University of Alabama at Birmingham (US)
- University of Chicago (US)
- University of Oklahoma (US)
- University of Pittsburgh (US)
- University of Cincinnati (US)
- University of Southern California (US)
- Wayne State University (US)
- National Institutes of Health (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2002-01-24
- Volume
- 346
- Issue
- 4
- Pages
- 250-255
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2066769587
- Cited by
- 205
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 8 · 2022: 8 · 2021: 8 · 2020: 6 · 2019: 5 · 2018: 9 · 2017: 10 · 2016: 10 · 2015: 5 · 2014: 3 · 2013: 13 · 2012: 9
- FWCI
- 11.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u10hd027889-02)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD19897, HD27905, HD27917, HD27883, U10HD027861, HD-27915, HD21434, HD-21414, HD-27860, HD27861, U10HD027917, U10HD027905, U10HD027860, HD27869, [HD21410, HD27889, U01HD019897, U10HD027883)
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- uterine contraction, contraction frequency, spontaneous preterm birth, preterm labor prediction, ambulatory monitoring, preterm birth screening, fetal fibronectin, cervical length, sensitivity and positive predictive value
- MeSH terms
- Cervix Uteri, Female, Fibronectins, Humans, Infant, Newborn, Infant, Premature, Obstetric Labor, Premature, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Risk, ROC Curve, Sensitivity and Specificity, Uterine Contraction, Multivariate Analysis, Logistic Models, Uterine Monitoring
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