Pre-term Labor Flashcards
Preterm labor
infant who born before 37 weeks gestation is consider preterm birth
34-36 =late preterm
<34= early preterm
preterm labor risk factors
history
previous preterm birth pregnant women born preterm short cervical length ( less than 25mm between 24-28 week) prior cervical surgery uterine surgery
preterm labor risk factors
maternal factors
smoking low maternal body weight (BMI 40 years stress substance abuse (cocaine crack heroin) low socioeconomic status
preterm labor risk factors
current pregnancy
cervical insufficiency/short cervix multiple gestation hydramnios (polyhydramnios) pyelonephritis severe maternal illness intrauterine infection imminent fetal jeopardy (isoimmuniztion with hydrops, fetal growth restriction with evidence of compromise)
preterm labor risk factors (associate factors)
asymptomatic bacteria lower uterine infection genital tract infections periodontal disease vaginal bleeding
preterm labor risk factors ( preventable iatrogenic)
failure to accurately determine gestational age
elective induction of labor
ill-timed cesarean birth
signs & symptoms of preterm labor
pelvic pressure lower back pain abdominal tightness or "cramps" contractions more than 6 per hour fetus dropping low into pelvis before 36 weeks increased vaginal discharge vaginal bleeding diarrhea.
Diagnose preterm labor
regular uterine contractions accompanied by a change in cervical dilation, effacement, or both or initial presentation with regular contractions and cervical dilation of at least 2cm
Cervical length
associated with preterm labor
short cervix
sonographic cervical length of 10-20mm (or less than 25mm) measured at 18 to 24 weeks’ gestation
women with very short cervix less than 15mm prior to 24 weeks gestation regardless of other risk factors need immediate medical consultation for consideration of cerclage placement. ***
Transvaginal Ultrasound
Gold Standard for cervical length measurement
fetal fibronectin
glycoprotiein that acts as an adhesive between the fetal membranes and the maternal decidua.
fetal fibronectin present in cervicovaginal secretions before 20 weeks gestation & after 37 weeks gestation.
not recommend to use as screening tool
what effect fetal fibronectin
sexual activity within 96 hours
vaginal bleeding
collect before digital examination
Sterile Speculum Examination
examine the cervix to see if it open (dilating or thinning (effacing)
find out how far the baby has moved down the birth canal (station)
check for fluid leaking from your vagina
Progesterone therapy
anti-inflammatory effect & increase progesterone in maternal tissue (decrease progesterone = labor)
use for women with hx of preterm & start at 16-36 weeks.
for asymptomatic women w/o prior preterm birth incidentally identified less than or equal to 20mm before 24 weeks of gestation.
progesteron does not reduce the incidence of preterm birth in women with twin or triplet
magnesium sulfate
for neuroprotection reduce occurence of cerebral palsy
given before 32 week
corticosteroids
accelerate fetal organ maturation
given between 24 weeks and 34 weeks of gestation who are at risk of preterm delivery w/in 7 days.
regardless of membrane status
Premature rupture of membrane
membrane rupture before labor and before 37 weeks of gestation
premature rupture of membrane etiology
intraamniotic infection history of preterm PROM short cervical length second & third trimester bleeding low body mass index low socioeconomic status cigarette smoking illicit drug use
complications/risk for PROM
respiratory distress sepsis intraventricular hemorrhage necrotizing enterocolitis neurodevelopmental impairment early gestational age at membrane rupture increase risk of white matter
diagnosis of PROM
visualization of amniotic fluid passing from cervical canal and pooling in the vagina;
a basic pH test of vaginal fluid
arborization (ferning) of dried vaginal fluid
normal vaginal secretion VS amniotic fluid
vaginal secretion 4.5-6.0
amniotic fluid 7.1-7.3
management of PROM
electronic fetal monitoring
uterine activity monitoring
determine gestational age
nonreassuring fetal status & clinical chorioamnionitis are indications for delivery.
vaginal bleeding should raise concern for abruption placentae
antibiotic for PROM
for preterm ROM less than 24 week
combination of erythromycin and ampicillin or amoxicillin is recommended.
corticosteroid for preterm labor
24-34 weeks
magnesium sulfate for PROM
before 32 weeks
tocolytic for PROM
not recommend
Gestational Diabetes Mellitus
glucose intolerance with onset or first recognition during pregnancy.
associated risk for GDM
obstetric morbidity
fetal macrosomia
perinatal death.
risk factors for GDM
age over 25 or 30 years old BMI over 25 or 27 Ethnic origin: non Caucasian women DMI or II or GDM in first degree relative Previous hx of GDM
sign & symptoms of GDM
fasting sugar >105 mg/dL or postprandial (2hours) >120mg/dL glycosuria loss of energy size larger than appropriate for dates polyuria polydipsia
DX / screening for GDM
50 gram 1 hour glucose challenge w/o previous fasting >130 mg/dL or 140mg/dL , then 3 hours glucose test if >200mg DX GDM 3 hours GTT @ 24-28 week fasting >95mg 1hr >180mg 2hr >155mg 3hr> 140mg
management diet for GDM
diet: Folate, six small meal, complex carb 35-40 of diet, fat 30% or less, 1800-2400kcal/day
* underwt: 40kcal/kg/day
* average wt: 30kcal/kg/day
* overweight 24kcal/kg/day
* obese: 12-15kcal/kg/day
oral hypoglycemic
more convenient, reduce risk of hypoglycemic compared to insulin
glyburide
use after organegenesis (3rd - 8th weeks)
metformin
first line oral medication
