Pre-term Labor

Question 1

Def of preterm labor

Answer 1

Cervical change associated with uterine contractions prior to 37 completed weeks and after 20 weeks.

Question 2

In a nulliparous woman, what findings are sufficient to call preterm labor?

Answer 2

Uterine contractions along with 2-cm dilation and effacement of 80%

Question 3

What are 4 RF for preterm labor?

Answer 3

1. Previous preterm labor or birth
2. cocaine abuse
3. pyelonephritis (and UTI)
4. abdominal trauma
5. cervical length less than 25mm
   * gonococcal cervicitis is strongly associated with PTL

Question 4

What is workup for suspected preterm labor?

Answer 4

1. history to asses for risk factors
2. speculum exam to look for ruptured membranes
3. serial cervical exams
4. fFN and transvaginal U/S to assess cervical length
5. UDS, UA, CBC, Tests for gonorrhea, culture for GBS, USG for fetal weight and presentation

Question 5

What are the two mainstays of treatment for preterm labor?

Answer 5

1. Tocolysis

2. steroid administration

Question 6

At what GAs are tocolytic agents considered

Answer 6

Gestational age less than 34-35 weeks

Question 7

At what GAs are steroids given?

Answer 7

Less than 34 weeks (between 24 and 34 weeks)

Question 8

What are 4 tocolytic agents used

Answer 8

1. Mag Sulfate
2. Terbutaline
3. Nifedipine
4. Indomethacin

Question 9

What are two side effects of magnesium

Answer 9

1. Pulmonary edema

2. respiratory depression

Question 10

What are three side effects of terbutaline? 3 contraindications?

Answer 10

1. Pulmonary edema
2. hyperglycemia
3. hypokalemia

• contraindicated in HTN, seizure d/o, and arrhythmia

Question 11

What are 4 side effects/ complications of nifedipine? What drug can these not be given with?

Answer 11

1. pulmonary edema (not as much as with terbutaline)
2. severe hypotension
3. CHF
4. MI

• do NOT use on someone on Mag, may cause dangerous hypotension

Question 12

What is a major side effect of indomethacin? When then is it contraindicated?

Answer 12

Can cause closure of the ductus arteriosus–> pulmonary HTN and oligohydramnios

• cannot use in third trimester (after 27 weeks)
• scenario: women given into now has variable deucels on FH tracing

Question 13

What two steroid agents are used?

Answer 13

1. betamethasone (2 doses)

2. dexamethasone (4 doses)

Question 14

benefits of steroid admin?

Answer 14

Reduce risk of RDS, IVH, NEC, neonatal death

Question 15

What are 6 contraindications to tocolytic use?

Answer 15

1. nonreassuring fetal status
2. chorioamnionitis
3. pre-e or ecampsia
4. fetal demise
5. fetal maturity
6. maternal hemodynamic instability

Question 16

What can be done to lower risk of PTL in women at high risk?

Answer 16

Weekly injections of 17a-hydroxyprogesterone caproate from 16 weeks to 36 weeks
*history of prior spontaneous preterm delivery