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Preterm Labor > Preterm Labor > Flashcards

Preterm Labor Flashcards

1
Q

PTL definition

A

Regular ctxns with change in cervical dilation/effacement or both OR Regular ctxns with cvx at least 2cm

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2
Q

Should we use FFN and cervical length assessments in acute situation

A

pos FFN or CL shortened alone poor PPV.

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3
Q

CI to tocolysis

A
  1. Chorio
  2. IUFD
  3. Lethal fetal anomaly
  4. Maternal bleeding with instability
  5. NRFHTs
  6. Severe PreE or Eclampsia
  7. Maternal specific CI to certain tocolytics
  8. PPROM (may be acceptable if no presence of infection and to stabilize for transfer or for steroid administration)
  9. Previable (in general, unless fetal surgery)
  10. > 34 wks
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4
Q

% of PTL who deliver at term

% PTL that resolves

A

50% deliver at term

30% resolve

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5
Q

PTCs without cervical change, should they get tocolytics?

A

No

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6
Q

Gestational age for corticosteroids

A

24-34 wks, who are at risk of PTB in 7 days.

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7
Q

Should you give corticosteroids even if you may not get 48hr benefit?

A

Yes, even less than 24 hrs of steroids have still shown a significant reduction in neonatal morbidity/mortality

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8
Q

Is there any additional benefit for accelerated dosing? Giving steroids sooner than recommended frequency?

A

No benefit has been shown

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9
Q

Betamethasone dose

A

12mg im x2, 24 hrs apart

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10
Q

Dexamethasone dose

A

6mg im x4, 12 hrs apart

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11
Q

When should rescue course of corticosteroids be given

A

If it has been 2 wks since first dose and less than 33 wks
Another study says 7 days since first dose and less than 34 wks, and at risk for PTB in 7 days.
Not recommended give more than 2 courses

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12
Q

Benefit of Mag for NP?

A

Decreases severity and risk of CP if given before 32 wks

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13
Q

What tocolytics should be used with caution with mag?

A

Beta agonist

Ca Channel blockers

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14
Q

If pt still in PTL with mag (with intent to use for tocolysis and NP), can you use another tocolytic at the same time?

A

Yes, but use certain ones with caution

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15
Q

Which tocolytic can be used with Mag? Limitation?

A

Indomethacin, before 32 wks

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16
Q

When should terbutiline be used?

A

Limited to short term use in acute tachysystole

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17
Q

Tocolytic superior in prolonging pregnancy when used as maintenance therapy?

A

Atosiban, but not available in the US–nonapeptide oxytocin analog (significant neonatal morbidity)

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18
Q

Does hydration and bed rest reduce PTB?

A

No. Careful with rec in those with PTL.

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19
Q

Multiple gestation can we use tocolytics? Mag? CS?

A

Tocolytics–no
Mag–yes for NP
CS–yes (but no studies have necessarily shown benefit, but there is benefit in singleton so we use it for multiples too)

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20
Q

What happens when you use Ca channel blockers with Mag?

A

decreased heart rate, contractility, and LV systolic pressure

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21
Q

Ca channel blocker CI?

A

Hypotension, heart lesions preload dependent such as Aortic insufficiency

22
Q

Ca channel blocker side effects?

A

Dizzy, flush, hypotension
increased liver enz
suppressed contractility, LV systolic pressure, HR if used with mag

23
Q

Ca channel blockers effects on fetus?

A

none

24
Q

INdomethacin fetal adverse effects

A

Oligo and in utero constriction of ductus arteriosus (greatest risk if used for greater than 48 hrs); patent ductus arteriosus (data is conflicting); nec. enterocolitis

25
Q

Maternal side effects of INdomethacin

A

Nausea, esophageal reflux, gastritis, and emesis; platelet dysfunction is rarely of clinical significance in patients without underlying bleeding disorder

26
Q

CI to indomethacin

A

Platelet dysfunction or bleeding disorder, hepatic dysfunction, gastrointestinal ulcerative disease, renal dysfunction, and asthma (in women with hypersensitivity to aspirin)

27
Q

Beta adrenergic maternal side effects (terb)

A

Tachycardia, hypotension, tremor, palpitations, shortness of breath, chest discomfort, pulmonary edema, hypokalemia, and hyperglycemia

28
Q

Terb CI in (beta adrenergic)

A

Tachycardia assoc cardiac disorder and uncontrolled diabetes

29
Q

Terb fetal side effects

A

Fetal tachy

30
Q

Mag side effects maternal

A

Causes flushing, diaphoresis, nausea, loss of deep tendon reflexes, respiratory depression, and cardiac arrest; suppresses heart rate, contractility and left ventricular systolic pressure when used with calcium channel blockers; and produces neuromuscular blockade when used with calcium-channel blocker

31
Q

Mag fetal side effects

A

Neonatal depression (not really seen when mag is used for NP alone)

32
Q

Mag CI

A

Myesthenia Gravis

33
Q

Should we screen CL measurements in women w/o h/o PTB?

A

Not necessarily recommended, but not discouraged either

34
Q

What if you have pt w/o h/o PTB, singleton gestation, incidentally short cervix? What if multiple gestation?

A
  • -vaginal progesterone if very short cervix less than 2.0cm before 24 wks
  • -pessary?? May be an option
  • -cerclage: not shown to decrease rate of PTB
  • -multiples, no intervention has been shown to improve outcomes.
35
Q

Short cervix found in pt with prior h/o PTB, singleton pregnancy, already getting 17OHP, now found to have short cervix?

A

CERCLAGE to consider if CL

36
Q

Should we use cerclage in twin pregnancy?

A

May increase the risk of PTB! Not recommended, even if CL is short

37
Q

Short cervix definition

A
38
Q

Cervical insufficiency

A

Inability for cervix to retain pregnancy in absence of uterine contractions/labor or both in second trimester

39
Q

Risk factors for cervical insufficiency

A

congenital müllerian anomalies, deficiencies in cervical collagen and elastin, and in utero exposure to diethylstilbestrol, prior LEEP/CKC, prior cervical dilation for ETOP, cervical laceration

40
Q

Transabdominal cerclage

A

Cervicoisthmic cerclage; Can be placed in late first or early second (10-14 wks) trimesters or in between pregnancies with subsequent C/S. Stays there permanently.

41
Q

Antibiotics needed for cerclage placement? What if GBS positive?

A

Nope…even if GBS pos

42
Q

Any difference between Shirodkar and McDonald?

A

Not really, no difference in effectiveness if used in first pregnancy, but maybe Shirodkar with increased birthweights if used in subsequent pregnancy

43
Q

Transabdominal cerclage technique

A

avascular space at the level of the cervicouterine junction between the lateral wall of the uterus and the ascending and descending branches of the uterine arteries is identified. A 15 cm long 5-mm Mersilene band is passed through this space from anterior to posterior. This can be achieved using a Mersilene band preloaded onto a needle, or by creating a tunnel through this avascular space and the posterior leaf of the broad ligament using a long right-angled forcep or Moynihan clamp. Care should be taken as the nearby veins are prone to injury. The identical procedure is repeated on the opposite side, except the needle is passed from posterior to anterior. Alternatively, the Mersilene band can be placed through the lateral myometrium to minimize the risk of trauma to the uterine vessels.

44
Q

When can you place cerclage if history indicated?

A

13-14 wks

45
Q

How long can we monitor serial CL measurements?

A

16-24 wks

46
Q

Why transabdominal cerclage riskier?

A

hemorrhage

47
Q

When should we remove vaginal cerclage?

A

36-37 wks in office is acceptable; if scheduled c/s, may remove right before c/s but need to consider risk of labor btwn 37-39 wks.

48
Q

PPROM with cerclage in place: remove cerclage?

A

cerclage retention with preterm PROM has been associated with increased rates of neonatal mortality from sepsis, neonatal sepsis, respiratory distress syndrome, and maternal chorioamnionitis but no strong recs to remove vs. keep cerclage; do not need longer than 7 days of latency abx

49
Q

Should you remove cerclage in PTL?

A

if cervical change, painful contractions, or vaginal bleeding progress, cerclage removal is recommended

50
Q

when is the latest you can place a cerclage?

A

23 wks.

Preterm Labor (1 decks)

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