Preterm Labor, Threatened - Case Management


	UM Guidelines

Preterm Labor, Threatened

Inpatient and Surgical Care (ISC) CMG: CM-110

BCBST modification effective June 26, 2008*

Deleted:

No deletions were made.

Added to Case Management: HUAM and Tocolytics Criteria

A 1996 ACOG Committee Opinion states:

"Data are insufficient to support a benefit from HUAM in preventing preterm birth. Therefore, the American College of Obstetricians and Gynecologists does not recommend the use if this system of care."

Nonetheless, BCBST recognizes that HUAM remains controversial and some providers endorse this surveillance tool as an adjunct in monitoring for PTL in a very select group of patients. Therefore, BCBST will cover HUAM between 24 and 36 weeks of gestation for these conditions only:

Post-op emergency cerclage.

Multiple gestations (> 3)

Uterine activity of contractions >4/hr by office monitor and 2cm dilation or cervical change of 1 cm.

Uterine activity of contractions >4/hr by office monitor and a positive Fetal Fibronectin.

Terbutaline Pump - ALL the following clinical indications must be met:

Persistent uterine contraction >4/hr and

Cervical change of 1cm or dilation to 2cm with positive Fetal Fibronectin and

Failed response to oral tocolytic therapy

SOURCES

American College of Obstetricians and Gynecologists. (2007). Guidelines for perinatal care, sixth edition. Retrieved January 15, 2008 from http://www.acog.org/navbar/current/publications.cfm.

American College of Obstetricians and Gynecologists. (2003). ACOG practice bulletin. Clinical management guidelines for obstetricians-gynecologists. Assessment of risk factors for preterm birth. No. 31. Retrieved January 15, 2008 from http://www.acog.org/publications/pdfs/pb043.pdf.

American College of Obstetricians and Gynecologists. (1999). Tocolytics for preterm labor: A systematic review. Retrieved February 28, 2006 from http://www.acog.org/.

BlueCross BlueShield of Tennessee network physicians.

* These guideline(s) have been revised from the Milliman USA Milliman Care Guidelines. The portions of the guideline(s) which have been revised are identified through the use of [insert: italic, boldface, underlined, etc. as appropriate] text, and Milliman USA has neither reviewed nor approved the modified material. Any statement to the contrary or association of the modified material with Milliman USA is strictly prohibited. This document has been classified as public information.

The above information only contains the modified portion of the Milliman Care Guideline. If you wish to view the complete Milliman Care Guideline, please contact Milliman USA.

	Added to Case Management: HUAM and Tocolytics Criteria


	A 1996 ACOG Committee Opinion states: "Data are insufficient to support a benefit from HUAM in preventing preterm birth. Therefore, the American College of Obstetricians and Gynecologists does not recommend the use if this system of care." Nonetheless, BCBST recognizes that HUAM remains controversial and some providers endorse this surveillance tool as an adjunct in monitoring for PTL in a very select group of patients. Therefore, BCBST will cover HUAM between 24 and 36 weeks of gestation for these conditions only: Post-op emergency cerclage. Multiple gestations (> 3) Uterine activity of contractions >4/hr by office monitor and 2cm dilation or cervical change of 1 cm. Uterine activity of contractions >4/hr by office monitor and a positive Fetal Fibronectin. Terbutaline Pump - ALL the following clinical indications must be met: Persistent uterine contraction >4/hr and Cervical change of 1cm or dilation to 2cm with positive Fetal Fibronectin and Failed response to oral tocolytic therapy SOURCES American College of Obstetricians and Gynecologists. (2007). Guidelines for perinatal care, sixth edition. Retrieved January 15, 2008 from http://www.acog.org/navbar/current/publications.cfm. American College of Obstetricians and Gynecologists. (2003). ACOG practice bulletin. Clinical management guidelines for obstetricians-gynecologists. Assessment of risk factors for preterm birth. No. 31. Retrieved January 15, 2008 from http://www.acog.org/publications/pdfs/pb043.pdf. American College of Obstetricians and Gynecologists. (1999). Tocolytics for preterm labor: A systematic review. Retrieved February 28, 2006 from http://www.acog.org/. BlueCross BlueShield of Tennessee network physicians.