Beckman Preterm Labor Flashcards
Preterm = before ____ weeks
37
most common cause of perinatal mobidity and mortality in the US
preterm birth
common complications of preterm birth
- respiratory distress
- intraventricular hemorrhage
- necrotizing enterocolitis
- sepsis
- neurologic impairment
- seizures
- perinatal death
“The __-___% of babies born prematurely account for ____% of all perinatal mortality and ___% of long-term neurologic impairment in US children”
11-12%
75% (mortality)
50% (neuro impairment)
2 general types of preterm births
- Spontaneous:
A. 50% (total) = spontaneous preterm labor with intact mem
B. 25-40% (total) = PPROM = preterm premature rom - Indicated
20-30% deliberate intervention
4 main pathogenic processes implicated in PTD
- activation of maternal/fetal HPA axis due to maternal/fetal stress
- Infection (decidual-chorioamniotic or systemic inflam)
- Decidual hemorrhage (abruption)
- Pathologic uterine distention (multifetal, poly, tumor)
strongest risk factors for preterm delivery (2)
Multifetal gestation
Prior preterm birth
behavior risk factors for PTL
low prepreg weight, smoking,
substance abuse, short interpregnancy interval
If women presents with preterm labor in a hospital without good neonatal ICU?
Transport to regional tertiary care center
Corticosteroid admin to mother at immediate risk for preterm birth (i.e. in preterm labor) decreases incidence of:
- resp. distress syndrome
- intraventricular hemorrhage
- morbidity/mortality
benefit of tocolytic therapy in women in preterm labor?
prolong preg for up to 48 hours to give time to administer corticosteroids
What is the benefit of magnesium sulfate admin prior to preterm brith?
decrease rate of cerebral palsy in preterm infants
Signs and sxs of preterm labor
- menstural-like cramps
- low, dull backache
- abdominal P
- pelvic P
- vaginal discharge
- uterine contractions, often painless
can cervical length be used as a dx factor for preterm brith?
Yes, as cervical length decreases in midpreg, risk increases.
how do we measure cervical length?
Transvaginal US
weekly intramuscular injections of _____ starting at ____-____ weeks until 36 weeks gestation in high risk woman can reduce spontaneous preterm birth
Progesterone
16-20 weeks
If rupture of fetal membranes is suspected, how should the cervix be evaluated?
First use speculum to assess dilation and effacement (digital exam increases risk of infection in setting of PROM)
In evaluating a patient suspected to be in preterm labor, why is a UA/urine culture obtained?
Because UTI can predispose a pt to uterine contractions
What is used for tocolysis in the setting of intrauterine infection?
Tocolysis is NOT appropriate in the setting of IUI
CI to using tocolytics
Advanced labor, mature fetus, IUI, signicant vag bleeding, severe preeclampsia, placental abruption
