IV access x2, ABCs
Fetal heart monitor
Immediate obstetrical consult
>30mm -<unk>  less likely
Observation of 6 hours might be appropriate
20-30mm - Increased risk for<unk> 
Fetal fibronectin result can assist, if over 50ng/ml manage<unk>  actively
<20mm -<unk>  very likely
Manage actively
Observation of 6 hours might be appropriate
Fetal fibronectin result can assist, if over 50ng/ml manage<unk>  actively
Manage actively
24-32 weeks
Magnesium sulfate (neuroprotection against cerebral palsy)
<34 weeks
Hospitalization
Betamethasone 12mg IM q24hrs x2 doses
Tocolytics (see below for options/dosages)
Antibiotics for GBS prophylaxis if status unknown
Other antibiotics only indicated in setting of active infection
Magnesium sulfate (neuroprotection against cerebral palsy)
Hospitalization
Betamethasone 12mg IM q24hrs x2 doses
Tocolytics (see below for options/dosages)
Antibiotics for GBS prophylaxis if status unknown
Other antibiotics only indicated in setting of active infection
Only if fetus would benefit from delay in delivery of 48 hrs
Gestational age 22wks - 34 wks
Transport to facility for definitive delivery
Delay in delivery for treatment of reversible condition possibly triggering<unk>  (UTI/pyelo)
Betamethasone requires approximately 48 hrs for maximal benefit for lung maturity, reducing intraventricular hemorrhage, NEC, and death
Tocolysis rarely effective for longer than 48 hrs
Does not remove underlying cause for tocolysis
Betamethasone requires approximately 48 hrs for maximal benefit for lung maturity, reducing intraventricular hemorrhage, NEC, and death
Tocolysis rarely effective for longer than 48 hrs
Does not remove underlying cause for tocolysis
Intrauterine fetal demise / lethal anomaly
Maternal hemorrhage or instability
Intraamniotic infection
Severe preeclampsia or eclampsia
Nonreassuring fetal status
Contraindications to the drugs
Indomethacin 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs. (avoid in gestation >32 weeks for concern of premature narrowing or closure of the ductus arteriosus)
Nifedipine 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx
Terbutaline 0.25mg sq q20-30 min up to 4 doses PRN ctx
Preterm labor
Emergent delivery
Placenta previa
Placental abruption
Septic abortion
Vasa previa
Preeclampsia
Uterine rupture