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3Y - OB > Preterm Birth > Flashcards

Preterm Birth Flashcards

1
Q

What is considered early preterm?

A

33 6/7 weeks or earlier

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2
Q

What is considered late preterm?

A

34 to 36 weeks

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3
Q

What is considered early term?

A

37 to 38 6/7 weeks

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4
Q

What is considered full term?

A

39 to 40 6/7 weeks

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5
Q

What is the ‘39-week rule’?

A

Adverse neonatal sequelae may result from elective delivery prior to 39 weeks

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6
Q

What are the fetal sizes by gestational age?

A

SGA (<10% BW), AGA (10th-90th%), LGA (>90%)

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7
Q

What are the common causes of preterm labor?

A

Uterine distention, maternal-fetal stress, cervical dysfunction, infection

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8
Q

What are the risk factors for uterine distention?

A

Multifetal pregnancy, hydramnios (more than 2L of amniotic fluid)

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9
Q

What maternal hormones play a role in preterm labor due to stress?

A

Corticotropin-releasing hormones causing premature rise in estrogen

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10
Q

What are common types of infections that cause preterm labor?

A

Transplacental, retrograde flow, ascending infection from vagina and cervix

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11
Q

What is Preterm Premature Rupture of Membranes (PPROM)?

A

A condition where the amniotic sac breaks before labor begins, leading to preterm birth.

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12
Q

What are the major predisposing factors for PPROM?

A

Oxidative stress, intrauterine infection, premature cellular senescence

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13
Q

How does multifetal pregnancy affect preterm labor?

A

Uterine distension leads to premature activation of contraction-associated proteins (CAPs)

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14
Q

What are lifestyle factors that contribute to preterm birth?

A

Age, poverty, short stature, extremes of maternal weight, smoking, drug use

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15
Q

What genetic factors contribute to preterm birth?

A

Immunoregulatory genes can potentiate chorioamnionitis and cause recurrent preterm birth

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16
Q

What is the most important risk factor for preterm labor?

A

Prior preterm birth

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17
Q

How do short intervals between pregnancies affect preterm birth?

A

Intervals <18 months increase the likelihood of preterm birth

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18
Q

What is the role of progesterone therapy in preventing preterm birth?

A

Progesterone helps maintain uterine quiescence and prevents early contractions

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19
Q

What is the role of cervical cerclage in preventing preterm birth?

A

It supports the cervix in women with cervical insufficiency or short cervix

20
Q

What is the guideline for corticosteroid use to accelerate fetal lung maturity?

A

Recommended for women with ruptured membranes between 24-34 weeks

21
Q

What are the key interventions for managing PPROM in pregnancies over 34 weeks?

A

Plan delivery, group B streptococcal prophylaxis, single corticosteroid course

22
Q

What antimicrobial therapy benefits exist in managing preterm labor?

A

Fewer women develop chorioamnionitis, fewer newborns develop sepsis

23
Q

What are the risk factors for clinical chorioamnionitis?

A

Maternal fever, low parity, multiple digital exams, use of internal uterine monitors

24
Q

What are the tocolytic agents used to delay labor?

A

Beta-adrenergic receptor drugs, magnesium sulfate, prostaglandin inhibitors

25
Q

What are the side effects of beta-adrenergic receptor drugs?

A

Pulmonary edema, sodium and water retention

26
Q

How is magnesium sulfate used in preterm labor management?

A

Given as a loading dose of 4g, followed by continuous infusion to delay labor

27
Q

What are calcium channel blockers used for in preterm labor?

A

Inhibit calcium entry in cells, reduce contractions (e.g., nifedipine)

28
Q

What is the function of fetal fibronectin?

A

It plays a role in intercellular adhesion during implantation and maintains placental adherence to the uterine wall.

29
Q

What does a positive fetal fibronectin test indicate?

A

It may indicate impending preterm labor if levels exceed 50 ng/mL in cervico-vaginal secretions.

30
Q

How is cervical length measured and what is considered short?

A

Cervical length is measured via transvaginal ultrasound; a short cervix is < 3cm.

31
Q

What is the purpose of cervical cerclage?

A

It is a surgical procedure to prevent premature dilation of the cervix in women at risk of preterm birth.

32
Q

What is the rationale for using corticosteroids in preterm birth management?

A

Corticosteroids accelerate fetal lung maturity and reduce the risk of respiratory distress syndrome (RDS).

33
Q

What are the symptoms of true preterm labor?

A

Regular contractions before 37 weeks, associated with cervical change.

34
Q

What is the role of amniocentesis in managing preterm labor?

A

It can help detect intrauterine infection but is not routinely used in preterm birth management.

35
Q

What is magnesium sulfate used for in preterm labor?

A

It provides neuroprotection and may reduce the incidence of cerebral palsy in preterm infants.

36
Q

What are the main contributors to preterm labor due to infection?

A

Bacterial vaginosis, chorioamnionitis, ascending infections from the vagina and cervix.

37
Q

What is the significance of Braxton Hicks contractions?

A

These are irregular, non-rhythmic contractions that can be mistaken for false labor.

38
Q

What are common medications used as tocolytics?

A

Magnesium sulfate, beta-adrenergic receptor drugs, prostaglandin inhibitors, calcium channel blockers.

39
Q

What lifestyle factors increase the risk of preterm birth?

A

Smoking, drug use, poor nutrition, low maternal weight gain, and physical activity extremes.

40
Q

What is the recommended management for preterm premature rupture of membranes (PPROM) at 34 weeks?

A

Delivery is recommended, along with group B streptococcal prophylaxis and corticosteroids.

41
Q

What genetic factors are linked to preterm birth?

A

Genetic mutations affecting collagen, elastic fibers, and immunoregulatory genes are implicated.

42
Q

What is a rescue cerclage?

A

A rescue cerclage is placed when cervical incompetence is identified in women with threatened preterm labor.

43
Q

What role do antimicrobials play in preterm labor?

A

Antimicrobials can prolong pregnancy by reducing infection-related preterm labor but should not be used routinely in women without infection.

44
Q

Oxytocin receptor antagonist in myometrium and decidua

A

Atosiban

45
Q

Prostaglandin inhibitor

A

Indomethacin
50-100 mg LD, 25-50 mg PO q8 for 1-2days

3Y - OB (10 decks)

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