Preterm Labor

Question 1

definition

Answer 1

reg cnx < 37 weeks
+
associated cervical change (dil, eff, or both)

Question 2

initial eval: HPI

Answer 2

cnx
menstrual-like cramping
pelvic pressure
vaginal spotting
backache

Question 3

initial eval: SSE steps

Answer 3

1. fFN!! (no gel, semen, BV) in posterior fornix for 10 sec
2. inspect cervix x dil, lesion, bleeding
3. GBS
4. if vag sx, wet mount swab
5. if no PNC, G/C swab

Question 4

some multip women have cervical dilation and _____

Answer 4

no other sx of PTL

Question 5

if vag bleeding and placenta location unknown…

Answer 5

US to r/o placenta previa before SDE

Question 6

PTL, don’t forget

Answer 6

EFM and TOCO

Question 7

PTL ABUS

Answer 7

fetal biometrics
AFI
presentation
placental location

Question 8

PTL TVUS

Answer 8

for cervical length (CL)

Question 9

appropriate CL in PTL

Answer 9

CL > 30 mm, PTL unlikely
CL 20-30 mm + cnx, PTL more likely
CL < 20 mm + cnx, high risk PTL

Question 10

PTL labs

Answer 10

fFN
UA
UCx
UDS
if no PNC, PNC labs

Question 11

criteria for admission for PTL

Answer 11

reg, painful cnx (>=6 cnx/hr)
ROM
vag bleed
>=3 cm dil and/or >=80% eff

Question 12

if dx of PTL is uncertain…

Answer 12

continue EFM and TOCO
re-examin cervix in 1-2 hr
fFM
CL by TVUS

*no need for tocolytics, IV hyd, or sedation

Question 13

fFN test specifics

Answer 13

low PPV = if positive, not helpful
low SP (SPIN) = if positive, not helpful
high SN (SNOUT) = if neg, helps rule out delivery in next 1-2 weeks
high NPV (69-92%) = if neg, less likely to deliver w/in 1-2 weeks

Question 14

fFN not accurate if…

Answer 14

contaminated with:

• blood
• semen
• gel

Question 15

do NOT perform fFN if…

Answer 15

< 24w
> 34w
ROM
>=3 cm dilated
anything in vagina for last 24 h
CL > 30 mm