Clinical 12 Preterm Birth

Question 1

Preterm Delivery Risk Factors

Answer 1

History of prior preterm delivery (17-40% recurrence rate, The earlier the prior delivery, the greater recurrence risk)
African American race 18% risk vs. 8% for Caucasian patients
Age 35
Low SES
Tobacco use (25% increased risk preterm birth)
Poor or excessive weight gain/low BMI
Abnormalities of AFV/oligo or poly
Multiple gestation, previa, abruption (Twins 36 wks, triplets 33 weeks, quads 31 weeks)

Question 2

• Predicting Preterm Labor

Answer 2

Fetal Fibronectin (present of fFN after 22 weeks indicates disruption to the decidua)
Positive fFN
6x incr. risk of delivery <1%

Question 3

Corticosteriod Therapy

Answer 3

Single most effective intervention to improve neonatal outcome
Administered between 24-34 wks
Repetitive dosing not indicated
1st line agent: betamethasone
Alt agent: dexamethasone
May be less effective reducing IVH/PVL

Question 4

Magnesium Sulfate and Tobutaline

Answer 4

tx for Pre-term labor

Question 5

PROM Etiology (11)

Answer 5

Intraamniotic infection
Low socioeconomic status
Low BMI
Preterm CTX
Cigarette smoking
Uterine overdistention
Short CL
Cerclage
Cervical conization
History prior PTD
Amniocentesis

Question 6

Expectant Management Pre-term Prom

Adjunctive antibiotic therapy

Answer 6

Widely studied and debated
NICHD-MFMU Research Network 1997
IV ampicillin/erythromycin 48 hours
Followed by oral amoxicillin/erythromycin 5 days
Decreased risk chorioamnionitis, increased latency
Reduced risk RDS, NEC, and PDA
Intrapartum GBS prophylaxis indicated regardless of prior antibiotic therapy
Oral erythromycin/extended spectrum ampicillin-clavulanic acid not beneficial