Part 2 Flashcards
time frame of childbirth considered premature
20-37 weeks
1 cause of neonatal morbidity and mortality
prematurity
cervical changes without uterine contractions are typically d/t
cervical insufficiency
cervical insufficiency definition
painless shortening or dilation of the cervix that occurs in the second or early 3rd trimester and results in preterm birth
cervical insufficiency is related to _____% of second trimester miscarriages
25%
cervical insufficiency is associated with what possible pathologies?
uterine anomalies DES exposure Cervical procedures (ie: conization)
what is cervical cerclage?
treatment for cervical insufficiency in which stitches are used to close the cervix during pregnancy in order to help prevent pregnancy loss or premature birth
When is cerclage done, removed, and who can’t get it?
- done around weeks 14-16
- removed around weeks 36-38
- ineligible if the mother has cervicitis, dilation > 4 cm, or if the membranes have already ruptured
what are braxton hicks contractions?
contractions that occur without causing cervical changes
painless contractions that are felt as tightening or pressure and
last 10-20 minutes
aka false labor
usually get better with walking/activity
how many contractions are needed in order for cervical change to occur
> 4/hour
what are contractions felt as?
abdominal tightening, low back pain, or pelvic pressure
in order to be termed “preterm labor” what must be present?
contractions that are causing cervical effacement or dilation
what is the cause of preterm labor?
no idea
what are some risk factors for preterm labor?
- Smoking
- Cocaine
- Uterine malformation
- Cervical incompetence
- Infection (STI, Group B Strep, UTI/Pyelo)
- Low pre-pregnancy weight of mother
what are some complications of preterm labor for the mother and fetus?
- Hypertension
- Diabetes
- Infection
- PROM
- Abruptio placentae
delivery of a baby
at a hospital with a NICU
cervical changes associated with preterm labor
- Dilation of > 2 cm at presentation
- Dilation of > 1 cm at serial exams
- Effacement > 80% (2 cm)
what are some late symptoms of preterm labor?
- Bloody mucus vaginal discharge (“bloody show”)
- Contractions, pressure, cramps, and low back pain
what cervical length (found on US) increases the risk of preterm labor?
cervical length of 2 cm at 24 weeks
what is significant about Fetal Fibronectin found in cervical/vaginal secretions?
if present, the risk raises for delivery of the fetus within 2 weeks
If cervical length is less than 4 cm and Fetal Fibronectin is absent =
50% chance of delivery before 34 weeks
If cervical length is 4 cm and Fetal Fibronectin is absent =
11% chance of delivery before 34 weeks
3 reasons to get amniocentesis for diagnosis of preterm labor
obtain lung maturity if estimated gestation date is uncertain
if you suspect chorioamnionitis
if the fetus is > 34 weeks gestation
how is preterm labor managed?
Decisions are made based on estimated gestation date, estimated weight of the fetus, and existence of contraindications to suppressing preterm labor