OBAb: Preterm Labor Flashcards
____ is preterm RUC but cervix is closed
threatened preterm labor
___ threshold of viability (both weeks and grams)
26 weeks, 750 grams
Note: DNR is <23 weeks, and <400g
____grams to be considered as VLBW
<1500grams
ELBW <1000g
LBW <2500g
____ risk increase of another preterm if prior preterm delivery if the first baby is less than 34 weeks
16x increased risk
If <35 weeks, 5x increased risk
___ risk increase of another preterm if the 1st and 2nd baby are <34 weeks
41x increased risk
Infection causes preterm delivery. Chorioamnionitis is usually cause by these 2 bacteria namely, ____ and ____
- Ureaplasma urealyticum
2. Mycoplasma hominis
ESR and CRP cut-off for infection
ESR >60
CRP >12
____ weeks AOG is the ideal time to do cerclage
14 to 22 weeks AOG
___ ng/mL of fetal fibronectin at 24-34 weeks may suggest preterm labor
more than 50ng/mL
(+) FFN increases the risk of preterm delivery in 7-10 days
What is the abnormal value for the cervical length at 24weeks AOG?
<=2.5cm
How will you give corticosteroids in patients suspected of preterm labor at 24-34 weeks AOG. For both Betamethasone and Dexamethasone.
Dexamethasone 6mg IM q12hrs x 4 doses
Betamethasone 12mg IM every 24 hours x 2 doses
Corticosteroids is given to prevent IVH
How will you administer nifedipine as tocolytic?
Loading dose: 30mg
Maintenance dose: 10-20mg q4-6hrs
What are the contraindications in giving tocolytics?
- Abruptio
- Severe pre-eclampsia
- Intrauterine infection
- lethal congenital anomaly
- Advanced cervical dilatation (>4cm)
This tocolytic should not be given for more than 48 to 72 hours since it may cause pulmonary edema.
Terbutaline
Aside from terbutaline, this beta mimetic drug is given for tocolysis.
Isoxuprine
Dont give this in placenta previa
in patients with a previous history of preterm labor with a short cervix, one can give this drug intravaginally (name the drug and dose)
Micronized progesterine (Utrogestan) 200mcg to max 800mcg OD
What are the clinical criteria for preterm labor?
- Contractions >/6 per hour
2. Cervix >/3cm, 80% effaced
When will you screen for cervical length?
16-24weeks
What is the normal length of the cervix?
> 2.5cm
What is the most common cause of preterm birth?
Placenta previa or placenta abruptio
How will you give the loading dose of magnesium sulfate
4-6g SIV over 20 mins
How will you give the maintenance dose of magnesium sulfate?
2g/hour for 24 to 48 hours
What is the tocolytic agent of choice?
Niedipine
LD 30 to 40mg/tab
MD: 30mg/day to 160mg/day in divided doses
To control preterm labor, progesterone is given ___
- Weekly 250mg IM from 16 to 20 weeks through 36 weeks
2. Daily 200mg/vaginal from 24 to 34 weeks AOG
[Pharma]
___ is an oxytocin receptor antagonis
Atosiban
What are the dreaded adverse effects of Indomethacin in patients with premature labor?
- Premature closure of ductus arteriosis
- Persistent PDA
- IVH
What is the standard antibiotic therapy for treating premature labor?
- Ampicillin2g IV q 6 hours PLUS
2. Gentamicin 1.5mg/kg every 8 hours
Prophylactic cerclage is done at ___ weeks AOG
10-12 weeks AOG
Corticosteroids are given between ___ for lung maturity
24 and 34 weeks AOG
What steroids will you give to facilitate lung maturity?
- Betametahsone 12mg/IM every 24 hours for 2 doses
2. Dexamethasone 6mg IM every 12 hours for 4 doses
What is the only reliable indicator of clinical chorioamninitis?
Fever
What are the criteria for chorioamnionitis
Maternal fever >/ 38 deg C PLUS 1:
- Fetal tachycardia
- Uterine tenderness
- Purulent or foul-smelling discharge
- Leukocytosis
- Increased ESR
What is the treatment regiment for maternal chorioamnionitis?
First 48 hours:
- Ampicillin 2g/IV q6
- Erythromycin 250mg q6
After 48 hours
- Amoxicillin 250mg q8hrs
- Erythromycin 250mg q8
[Fetal Growth Disorders]
Symmetrical growth retardation is due to an early insult resulting to ____
- Decrease cell number and size
2. Proportionate reduction of both head and body
