OBJECTIVE: To evaluate three management strategies and assess pregnancy outcomes in women who present with preterm uterine contractions (UC). STUDY DESIGN: We randomized women who presented to our L&D triage to observation alone (OBS) or the addition of either intravenous hydration (IVF), or one dose of subcutaneous terbutaline (TRB). Eligible patients had a singleton pregnancy, intact membranes, were at >20 and <34 weeks' gestation, had >3 UC30 minutes, and were dilated 1 cm and effaced <80%. Women who developed preterm labor (PTL) had progressive cervical change at <34 weeks and were admitted and treated with intravenous MgSO4. Women remained in their assigned group for subsequent triage visits. We calculated that a sample size of 153 women would be required to demonstrate a two week intergroup difference in mean days to delivery (DEL) (α = 0.05 and β= 0.2). RESULTS: We randomized 179 women: 62 IVF, 56 OBS, and 61 TRB. The groups were similar with respect to maternal age, race, parity, prior preterm births, gestational age (29.8 ±2.9 weeks), UC (6.6 ±3.530 min), and mean initial cervical dilation (0.2 ±0.4 cm). Outcome IVF OBS TRB p value Days to DEL 56 ±27 60 ±25 60 ±26 0.6 Repeat triage visits 1.7 + 1.1 1.4 + 0.7 1.9 + 1.2 0.1 PTL <34 weeks 13% 18% 15% 0.7 DEL <34 weeks 6.4% 8.9% 6.6% 0.8 DEL <37 weeks 31% 23% 16% 0.2 Women who received TRB stopped contracting and were discharged earlier (TRB 4.1 ±5 hrs, OBS 5.2 ±5 hrs, IVF 6.0 ±6 hrs; p - 0.003). No complications related to IVF or TRB were observed. CONCLUSIONS: The use of IVF in the management of preterm UC was of no benefit. TRB is inexpensive, safe and resulted in the shortest length of stay in the triage unit.