Preterm Labor Flashcards
What is the greatest risk factor for preterm labor?
previous preterm birth
How is preterm labor defined?
birth prior to 37 weeks
What lab test do we use to measure preterm labor?
fetal fibronectin
Fetal fibronectin has a very high _____ predictive value.
negative
Cervical length assessment is recommended for preterm labor until how many weeks?
24 weeks
What is the first thing you should do for maternal hemorrhage with hemodynamic instability? (this question will be on exam)
make sure mother is ok
What are the 4 basic things that are always done in the management of preterm labor?
- steroids
- tocolytic drugs
- neuroprotection
- antibiotics (GBS prophylaxis)
What do tocolytic drugs do?
stop uterine contractions
What are the 3 most common tocolytic agents used to treat preterm labor?
- magnesium sulfate
- indomethacin
- nifedipine
What are the only 2 indications in which terbutaline is still used?
- external cephalic version
- hyperstimulation
What are the 3 contraindications for terbutaline?
- maternal cardiac disease
- hemorrhage
- diabetes
This drug is commonly used in patients at risk for preterm delivery to reduce the risk for cerebral palsy.
magnesium sulfate
What is the antidote for magnesium toxicity?
calcium gluconate IV
what are the 3 contraindications for magnesium?
- myasthenia gravis
- maternal cardiac conduction defects
- maternal renal impaiment
What is the risk of concomitant use of CCB with magnesium?
- respiratory depression
You should have caution when administering Nifedipine in women with this condition.
left ventricular dysfunction and CHF
Indomethacin can be used until how many weeks?
28-29 weeks
Indomethacin administration is contraindicated in these 5 conditions.
- platelet dysfunction or bleeding disorders
- hepatic dysfunction
- GI ulcerative disease
- asthma
- renal dysfunction
This medication is an appropriate first-line tocolytic for early preterm labor (<30 wk) or preterm labor associated with polyhydramnios.
indomethacin
What is the main goal with tocolytics?
- delay pregnancy by 48 hours to complete a steroid course
Administering this drug is known to decrease risks of most neonatal complications (IVH, NEC, respiratory distress).
- Steroids (Bethamethasone [Celestone])
What is the difference in PROM and PPROM in terms of when the rupture of the membrane happened?
- PROM = rupture before onset of labor
- PPROM = rupture before 37 weeks of gestation
What is the first physical exam you should do in a patient with suspected ruptured membranes?
speculum exam
This diagnostic test is only used if PPROM cannot be clinically diagnosed.
Dye test
What is the treatment for PROM?
- induction of labor
What is the primary maternal risk with expectant management of PPROM?
infection
At how many weeks can you deliver a PPROM pregnancy?
34+ weeks
What are the 3 possible options for preventing recurrent preterm delivery?
- progesterone supplements
- cervical cerclage
- cervical pessary
What are the 3 common diagnostic tests used for PROM/PPROM?
- Nitrazine test = paper turns blue in presence of amniotic fluid
- Fern test = amniotic fluid has narrow fern
- amniotic fluid index with u/s
If the Amnisure or the ROM+ test is positive what does this mean?
patient has ruptured membranes
