Beckman Preterm Labor

Question 1

Preterm = before ____ weeks

Answer 1

37

Question 2

most common cause of perinatal mobidity and mortality in the US

Answer 2

preterm birth

Question 3

common complications of preterm birth

Answer 3

1. respiratory distress
2. intraventricular hemorrhage
3. necrotizing enterocolitis
4. sepsis
5. neurologic impairment
6. seizures
7. perinatal death

Question 4

“The __-___% of babies born prematurely account for ____% of all perinatal mortality and ___% of long-term neurologic impairment in US children”

Answer 4

11-12%

75% (mortality)

50% (neuro impairment)

Question 5

2 general types of preterm births

Answer 5

1. Spontaneous:
   A. 50% (total) = spontaneous preterm labor with intact mem
   B. 25-40% (total) = PPROM = preterm premature rom
2. Indicated
   20-30% deliberate intervention

Question 6

4 main pathogenic processes implicated in PTD

Answer 6

1. activation of maternal/fetal HPA axis due to maternal/fetal stress
2. Infection (decidual-chorioamniotic or systemic inflam)
3. Decidual hemorrhage (abruption)
4. Pathologic uterine distention (multifetal, poly, tumor)

Question 7

strongest risk factors for preterm delivery (2)

Answer 7

Multifetal gestation

Prior preterm birth

Question 8

behavior risk factors for PTL

Answer 8

low prepreg weight, smoking,

substance abuse, short interpregnancy interval

Question 9

If women presents with preterm labor in a hospital without good neonatal ICU?

Answer 9

Transport to regional tertiary care center

Question 10

Corticosteroid admin to mother at immediate risk for preterm birth (i.e. in preterm labor) decreases incidence of:

Answer 10

1. resp. distress syndrome
2. intraventricular hemorrhage
3. morbidity/mortality

Question 11

benefit of tocolytic therapy in women in preterm labor?

Answer 11

prolong preg for up to 48 hours to give time to administer corticosteroids

Question 12

What is the benefit of magnesium sulfate admin prior to preterm brith?

Answer 12

decrease rate of cerebral palsy in preterm infants

Question 13

Signs and sxs of preterm labor

Answer 13

1. menstural-like cramps
2. low, dull backache
3. abdominal P
4. pelvic P
5. vaginal discharge
6. uterine contractions, often painless

Question 14

can cervical length be used as a dx factor for preterm brith?

Answer 14

Yes, as cervical length decreases in midpreg, risk increases.

Question 15

how do we measure cervical length?

Answer 15

Transvaginal US

Question 16

weekly intramuscular injections of _____ starting at ____-____ weeks until 36 weeks gestation in high risk woman can reduce spontaneous preterm birth

Answer 16

Progesterone

16-20 weeks

Question 17

If rupture of fetal membranes is suspected, how should the cervix be evaluated?

Answer 17

First use speculum to assess dilation and effacement (digital exam increases risk of infection in setting of PROM)

Question 18

In evaluating a patient suspected to be in preterm labor, why is a UA/urine culture obtained?

Answer 18

Because UTI can predispose a pt to uterine contractions

Question 19

What is used for tocolysis in the setting of intrauterine infection?

Answer 19

Tocolysis is NOT appropriate in the setting of IUI

Question 20

CI to using tocolytics

Answer 20

Advanced labor, mature fetus, IUI, signicant vag bleeding, severe preeclampsia, placental abruption