Preterm Birth and Cervical Cancer'

Question 1

What are 8 risk factors for preterm deliver?

Answer 1

1. Previous Hx of preterm delivery
2. African American race
3. Age outside 17-35 range
4. Low socioeconomic status
5. Tobacco use
6. Poor or Excessive Weight gain
7. Abnormal amniotic fluid volume
8. Multiple gestation, previa, abruption

Question 2

Most beneficial drug class to intervene with preterm labor.

Answer 2

corticosteroids

Question 3

What is fetal fibronectin (fFN)?

Answer 3

An extracellular matrix protein that helps attach the fetal membranes to the decidua, it is normally present in cervicovaginal secretions before 18 weeks gestation and after delivery.

Question 4

What does the presence of fFN in cervicovaginal secretion after 22 weeks gestation indicate?

Answer 4

Marker for disruption of the decidual-chorionic interface.

6x increase risk of preterm if detected at less than 35 weeks gestation

14x increase risk of preterm labor if detected at less than 28 weeks gestation

High risk of delivery within 1-2 weeks of (+) test

Question 5

Main tocolytic and beta mimetic used for preterm therapy.

Answer 5

Tocolytic: Magnesium Sulfate

B-mimetic: Terbutaline

Question 6

Antidote for Magnesium Sulfate overdose

Answer 6

Calcium Gluconate

Question 7

What is the 1st line corticosteroid and the alternative agent used for preterm labor?

Answer 7

1st line: betamethasone
2nd line: dexamethasone

(administered between 24-34 weeks)

Question 8

In summary: what is the management strategy for medications to treat preterm labor?

Answer 8

Use magnesium sulfate or terbutaline only for 24-48 hrs until the corticosteroids start to take effect.

Question 9

Causes of premature rupture of membranes (PROM).

Answer 9

low BMI
Cerclage: stitching of cervix to prevent dilation
intraamniotic infection
low socioeconomic status
preterm contraction
smoking
uterine overdistension
amniocentesis

Question 10

What is the regimen for adjunctive antibiotic therapy in PROM?

Answer 10

Intrapartum group B strep (GBS) prophylaxis indicated regardless of prior antibiotic therapy.

1. IV ampicillin/erythromycin for 48hrs
2. Follw with oral amoxicillin/erythromycin for 5 days

Question 11

2 HPV genotypes most commonly associated with cervical cancer.

Answer 11

16, 18

Question 12

What 3 risk factors are known to increase persistence of an HPV infection and risk development of cervical cancer?

Answer 12

Cigarette smoking
compromised immune system
HIV infection

Question 13

What is the management strategy for women over 30 that are HPV (+) but cytology (-)? Meaning women that have HPV but don’t have any cervical cell transformation indicating cancer.

Answer 13

1. Repeat test in 1 year
   - if negative again and/or HPV negative go back to testing every 3 years
   - if still HPV positive OR there is atypical squamous cells (ASC) do a colposcopy
2. HPV DNA typing
   - if the HPV is 16 or 18, do a colposcopy
   - if the HPV is neither, repeat test in 1 year

Question 14

What is the management strategy for women over 30 that have Atypical Squamous Cells of Undetermined Significance (ASC-US) on cytology?

Answer 14

1. Preferred to do HPV testing
   - if negative, repeat test every 3 years
   - if positive, do colposcopy
2. Also repeat the cytology in 1 year
   - if negative, normal screening
   - if positive again, do colposcopy

Question 15

What is the management for women over 25 that have atypical squamous cells high grade (ASC-H)?

Answer 15

Colposcopy

-HPV testing not necessary, women with ASC-H at this young age almost always have HPV