Pre-term Labor Flashcards
Defintion of PTL
onset of regular contractions and cervical changes prior to 37 weeks
Incidence
5-10% of all pregnancies = preterm
1% =
Risk factors of PTL/ aeitiology
IDIOPATHIC = COMMONEST
Maternal
- low SES
- smoker
- alcohol
- stress
- infection + genital infection
- APH
- HPTN
- DM
Materno-fetal
- PPROM
- Polyhydramnios
- Placenta Previa/abruption/insufficiency
Fetal
- congenital abnormalities
- multiple gestation
- fetal hydrops
Prediction of PTL
- Maternal risk scores
- PHx of PTL
- BV infection
- Cervical length
- Fetal fibronectin
Diagnosis of PTL and clinical features
By History
regular contractions 2:10 with cervix >2cm dilated/ documented change
initial Mx of PTL
- transfer to appropriate facility
- IV fluid hydration
- sedation
- bed rest + LLDP
- avoid PE exams
6 USS scan - notify NICU
What cervical length excludes PTL?
> 30mm
How do you screen for BV and Rx?
high vaginal swab and metronidazole
When is fFN useful?
in symptomatic women 24-32 weeks with intact membranes determines risk of PTL
Second line Mx of PTL
- Tocolysis: buys time (24-34 weeks)
- Steroids : promote lung maturation (24-34 weeks)
- cervical clercage
- Less than 32 weeks? –> MAG SULFATE
- ABx ONLY IF PPROM
Approaching woman with PTL
History
Exam
- General
- Vitals
- Abdo palp
- CTG
- bedside USS
- sterile spec
Ix
- bloods
- fFN
- high vaginal swabs for BV
- cervical length estimate
Mx
as above
initial vs second line
When do you give steroids?
24-34 weeks (Same as tocolytics)
w/ PPROM, elective early deliver or PTL
How to Prevent PTL in future deliveries?
- Progesterone • Cervical cerclage • Reducing multiple pregnancy rates • Treatment of asymptomatic bacteruria or UTI • Screening for bacterial vaginosis
