Exam 2: premature labor

Question 1

Preterm labor

Answer 1

cervical changes (at least 2 cm) and uterine contractions occurring between 20 to 37 weeks of pregnancy

Question 2

sub categories

Answer 2

very preterm: less than 32 weeks
moderately preterm: 32-34 weeks
late preterm: 34-37 weeks

Question 3

pre term birth is length of

Answer 3

gestation regardless of birth weight

Question 4

low birth weight

Answer 4

less than 2500 grams at birth

Question 5

Causes of spontaneous pre term labor and birth

Answer 5

infection
multifactorial
congenital abnormality
placental causes
decrease in progesterone

Question 6

Predicting spontaneous preterm labor and birth: fetal fibronectin

Answer 6

weeks 24 to 34, there should be little RbN in vaginal secretion

women with a negative test have less than a 1% chance of going into labor early (within 2 weeks)

Question 7

Predicting spontaneous preterm labor and birth: salivary estriol

Answer 7

3-5 weeks before labor begins the amount increases dramatically

less reliable

Question 8

Preterm labor contraction pattern

Answer 8

four contractions every 20 minutes or 8 in an hour

Question 9

fetal fibronectin

Answer 9

glycoprotein produced by the chorion

Question 10

cervical length over ________ mm in 2nd and 3rd trimester are unlikely to give birth prematurely

Answer 10

30

Question 11

Cervical length measuring is performed at

Answer 11

16 to 24 weeks gestation

length of 3cm or more indicates delivery within 14 days unlikely

Question 12

What medication type do we give to suppress uterine activity

Answer 12

tocolytics: goal is to delay birth long enough to institute interventions that delay neonatal morbidity and mortality

Question 13

e.g. of tocolytics

Answer 13

Mg sulfate (most commonly used)
terbutaline
nifedipine
indomethacin

“it’s not my time”

Question 14

How long an tocolytics give

Answer 14

48 hours to several days to allow for sufficient time to administer steroids

Question 15

Nifedipine

Answer 15

calcium channel blockers –> suppresses contractions, watch for orthostatic hypotension

Question 16

Mg sulfate

Answer 16

relaxes smooth muscle in the uterus

watch for magnesium toxicity (decreased DTR, urine output less than 30 mL/hr, respiratory depression)

Admin calcium gluconate for toxicity

Question 17

Indomethacin

Answer 17

NSAID that blocks prostaglandin synthesis therefore suppressing labor

Question 18

Betamethoasone

Answer 18

glucocorticoid that promotes fetal lung maturity (given 24-48 hours prior to birth)

Question 19

Labor progressed to cervical dilation of ____ cm likely leads to inevitable preterm birth

Answer 19

4