15 - Preterm Labor & PROM

Question 1

Preterm labor [PTL] and its subclasses:

Answer 1

— Before 37 weeks

— Late preterm = 34–36
Moderately preterm = 32–33
Very preterm = <32
Extremely preterm = <28

Question 2

Preterm definition by birth weight:

Answer 2

Low BW = <2500g
VLBW = <1500g
Extreme LBW = <1000g

Question 3

Preterm causes:

Answer 3

1– Spontaneous preterm labor 
2– Multiple gestations
3– PROM
4– Preeclampsia
5– Antepartum bleeding
6– IUGR
7– Cervical anomalies

Question 4

4 primary processes of the preterm labor:

Answer 4

1– Activation of the hypothalamic-pituitary-adrenal axis
2– Infections
3– Hemorrhage
4– Pathological uterine distention

Question 5

PTL R/F:

Answer 5

1– Maternal stress [Psychological]
2– Occupational fatigue [Physical stress]
3– Excessive or impaired uterine distention [Multiple gestation, polyhydraminos, uterine anomaly, LEIOMYOMAS, diETHYLstillBESTROL]
4– Cervical abnormal history [Hx of cervical surgery or 2nd trimester abortion]
5– Infections [STD, pneumonia etc.]
6– Placenta previa/Abruption [Hemorrhage]
7– Smoking and previous preterm delivery
8– Congenital anomaly and IUGR

Question 6

PTL diagnosis and its criteria:

Answer 6

—Speculum and DVE

— Regular painful contractions + cervical dilation

Question 7

PTL #Lab:

Answer 7

1– Urine culture [For infections]
2– Rectovaginal group B streptococcal culture [For antibiotic prophylaxis]
3– Test for bacteria presence [gonorrhea and chlamydia]
4– Fetal fibronectin [fFN]
6– Cocaine

Question 8

Cervical lengths and the PTL risks:

Answer 8

1– >30mm = Not high risk
2– 20–30mm = Send for fFN, if +ve —> Try to prevent morbidity
3– <20mm = High risk

Question 9

PTL management:

Answer 9

1– ABs
2– Glucocorticoids
3– Tocolytics [To maximize glucocorticoids effect]

Question 10

Tocolytics and 3 examples:

Answer 10

— Effective in delaying birth for up to 7 days

— Nifidipine, Astosiban, Ritodrine

Question 11

Risk of using NSAIDS in third trimester:

Answer 11

Increase the risk of premature ductal closure

Question 12

Ca channel blockers significance:

Answer 12

Decrease patients giving birth within 7 days of treatment

Question 13

Nifedipine adverse effect and contraindications:

Answer 13

1– Flushing
2– N&V
3– Palpitations
4– Hypotension

— In cardiac and DM patients [Due to the risk of PE]

Question 14

Atosiban adverse effects and contraindications:

Answer 14

1– N&V
2– Dyspnea

— None [Unlike nifedipine]

Question 15

Stopped somewhere

Answer 15

The rest is bs anyway