Obstetrical Complications PRETERM LABOR (Wootton)

Question 1

1/2) What two requirements to make diagnosis of preterm labor?

3) Occurs between when?
4) What race is most likely to have preterm labor?

Answer 1

1) Uterine contractions
2) cervical change/dilation of 2 cm or greater AND/OR 80% effacement

3) 20-37 weeks
4) African Americans

Question 2

The prevention of preterm labor is aimed at what four main pathways?

Answer 2

1) Infection (cervical)
2) Placental-vascular
3) Psychosocial stress
4) Uterine stretch

IPPU

Question 3

In the infection-cervical pathway what is associated with preterm delivery?

What can this increase the risk for?

Answer 3

Bacterial Vaginosis

Gonorrhea and Chlamyidia

Question 4

1) In the treatment of women in preterm labor with antibiotics what infections do you want to make sure you treat for as they are a known risk factor for preterm labor?
2) What Antibiotic is given?

Answer 4

1) Group B strep

2) Penicillin (baby)

Question 5

What are screening tools of cervical length to assess risk of preterm labor?

Answer 5

1) Ultrasound

2) Fetal fibronectin

Question 6

Alteration of what components in the placental-vascular pathway may result in poor fetal growth (which is a risk factor for preterm labor)?

Answer 6

1) Low resistance connection of spiral arteries
2) Immunologic component
3) Vascular component

LIV

Question 7

In the stress-strain pathway, mental and physical stress are thought to induce a stress response that increases the release of __1__ and __2__.

Answer 7

1) Cortisol

2) Catecholamines

Question 8

Increased cortisol which is released from the adrenal glands can play a role in preterm labor because it stimulates increased __1__ levels which are known to assist in labor at term.

Catecholamines which affect blood flow can also play a role in preterm labor because they can cause __2__.

Answer 8

1) Corticotropin-releasing hormone (CRH)

2) Uterine contractions

Question 9

1) What is uterine stretch pathway caused by?

2) What are risk factors?

Answer 9

1) Increased volume

2) Polyhydramnios and multiple gestations

Question 10

In the evaluation of preterm labor, what will resolve contractions in about 20% of patients?

Answer 10

Hydration and rest

Question 11

In the evaluation of preterm labor, cultures should be taken for?

Answer 11

1) Group B strep
2) Gardnerella
3) Gonorrhea and chlamydia

GGG

Question 12

If diagnosed 2 cm and/or 80% effaced or made cervical change then begin tocolysis-delaying pregnancy (if gestational age is less than 34 weeks and no contraindication).
What are the options for tocolytic drugs?

Answer 12

1) Magnesium sulfate
2) Nifedipine
3) Prostaglandin Synthetase Inhibitors (indomethacin)

Question 13

__1__ is the tocolytic drug of choice in the U.S.

It acts on the cellular level and competes with __2__ for entry into the cell at the time of depolarization.

Typically a 6 gm load __3__ is given and then a 3 gm hour continuous maintenance.

Answer 13

1) Magnesium sulfate
2) Calcium
3) Intravenously

Question 14

Some recent studies have shown magnesium sulfate may be more important in the role of __1__.

It may offer prevention against __2__.

Answer 14

1) Neuroprotection

2) Cerebral palsy

Question 15

What maternal side effect may be seen with magnesium sulfate serum levels of 12-15 mg/dL?

What may be seen at high serum levels >30 mg/dL?

Answer 15

1) Respiratory depression

2) Cardiac conduction defects

Question 16

Nifedipine is an __1__ agent effective in suppressing preterm labor.

It inhibits slow, inward current of __2__ during the second phase of the action potential.

Answer 16

1) Oral

2) Calcium

Question 17

Prostaglandin Synthetase Inhibitors inhibit prostaglandin production that induce __1__ contractions.

It is indicated for __2__ prematurity.

__3__ is the most commonly used agent.

Answer 17

1) Myometrial contractions
2) Extreme
3) Indomethacin

Question 18

Indomethacin can decrease fetal renal function which can lead to __1__.

It can cause premature closure of fetal ductus arteriosus and result in __2__.

Answer 18

1) Oligohydramnios

2) Pulmonary HTN and heart failure

Question 19

1) What is used to mature the premature fetal lung?
2) when is is given?

3) Either 2 doses of 12mg of what is given 24 hours apart or
4) 4 doses of what given every 12 hours?

Answer 19

1) Glucocorticoids
2) Between 24 and 34 weeks
3) Betamethasone
4) Dexamethasone

Question 20

What should be given to pregnant woman at 34-36 weeks at risk of preterm birth within 7 days?

Answer 20

Betamethasone

Question 21

What is the main drug used in PREVENTION of preterm labor?

Answer 21

Progesterone

smooth muscle relaxor

Question 22

In the prevention of preterm labor, what is used in women with shortened cervix?

Answer 22

1) Progesterone

2) Arabin pessary