Preterm Labor Flashcards

1
Q

How do you define preterm labor?

A

Cervical length of 3cm of more in the setting of contraction

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2
Q

What are the risk factors for preterm labor?

A

-Strongest risk factor is history of preterm labor and delivery
-Short interval pregnancy
-Infection
Polyhydramnios
Short cervix
-Multiple gestation
-PPROM

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3
Q

How do you manage a patient with preterm labor in pregnancy?

A

NICHD counseling in periviable period
When viable then magnesium for neuroprotection, indocin for tocolysis, betamethasone, ampicillin or penicillin for GBS pox

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4
Q

What tocolytic do you use for preterm labor treatment?

A
  • NSAIDS before 32 weeks
  • Calcium channel blocker
  • Terbutaline
  • Magnesium
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5
Q

What is the role of terbutaline in the management of preterm labor?

A

Typically given in the intrapartum setting, works quickly

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6
Q

What are the potential complications of prolonged terbutaline use in a pregnant woman?

A

pulmonary edema

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7
Q

Who do you consider a candidate for tocolysis?

A

before steroid completion

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8
Q

Will you tocolyze a previable gestation?

A

no

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9
Q

How long do you continue steroid completion?

A

Until steroid completion

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10
Q

Is there a role for oral tocolysis beyond 48-72 hours?

A

not recommended due to risk of infection being masked

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11
Q

What are the risks of chronic NSAID use in pregnancy or beyond 32 weeks gestation?

A

Oligohydramnios
Constriction of ductus arteriosus
NEC preterm newborns

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12
Q

What are contraindications to tocolysis for a patient with preterm labor?

A
Abruption 
Active infection 
IUFD
Lethal fetal anomaly
Pec
Pprom
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13
Q

Who is a candidate for corticosteroids for fetal benefit?

A

23-34 weeks

OR after 34 weeks before 37 weeks if no previous steroid administration

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14
Q

Who is a candidate for rescue steroids?

A

7 days from initial steroid course

OR after 34 weeks before 37 weeks if no previous steroid administration

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15
Q

Do you give more than 2 courses of steroids for fetal benefit?

A

7 days from initial steroid course

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16
Q

What is the earliest and latest gestational age you will give steroids for fetal benefit?

A

23 weeks and 36 weeks

17
Q

How does magnesium provide fetal benefit?

A

Decreases brain activity
Neuroprotective
Dec risk of CP

18
Q

Who is a candidate for magnesium for fetal neuroprotection?

A

Less than 32 weeks and greater than 23 weeks

19
Q

Describe your regimen for magnesium for fetal neuroprotection.

A

4-6 grams loading and then 1-2 grams per hour

20
Q

Who should receive GBS ppx?

A
less than 37 weeks without GBS status known
Naat gbs status
Arom > 18hr
Fever > 100.4
Prior child affected 
GBS bateruria
21
Q

How do you manage a patient with preterm labor and unknown GBS status?

A

Start antibiotics after collecting GBS

22
Q

How do you manage GBS ppx in a patient with low risk allergy to PCN?

A

Ancef 2g, then 1g every 8hrs

23
Q

How do you manage GBS pix in a patient with high risk allergy to PCN?

A

GBS sensitivity, if sensitive to Clinda + Erythro then give clindamycin if not give vancomycin

24
Q

When is a patient a candidate for discharge from hospital following treatment of preterm labor?

A

Depends on gestational age and distance to hospital

25
What is the role of bedrest in the management of preterm labor?
it does not improve the outcome
26
Do you manage twin gestation with PTL differently from a singleton?
no
27
How do you counsel a patient about future pregnancy risk and management if she delivers prematurely due to preterm labor?
strongest risk factor for preterm delivery is history of preterm delivery
28
Candidates for 17OHP
- Prior delivery between 20-36 6/7 weeks - Initiate at 16-21 6/7 but as late as 23 6/7 - Singleton pregnancy
29
Antenatal Betamethasone for Women at Risk for Late Preterm Delivery (ALPS trial):
Population: women at risk of preterm delivery between 34 -36 weeks (16% typically need CPAP or ventilator) Intervention: betamethasone Comparison: placebo Outcome: respiratory morbidity and stillbirth/neonatal death within 72 hours Conclusion: Administration of betamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications.
30
Beneficial Effects of Antenatal Magnesium Sulfate (BEAM study):
Population: women at imminent risk of preterm delivery at 24-31 weeks Intervention: magnesium sulfate Comparison: placebo Outcome: composite cerebral palsy or IUFD/infant demise. CP was assessed at 2 years of age. Conclusion: Fetal exposure to magnesium sulfate in women at risk for preterm delivery significantly reduces the risk of cerebral palsy without increasing the risk of death.
31
Progestins Role in Optimizing Neonatal Gestation (PROLONG) study:
Population: women with history of preterm birth Intervention: progesterone injections (250mg 17OHP) Control: placebo Outcome: delivery at less than 35 weeks and neonatal morbidity Conclusion: 17-OHPC did not decrease recurrent PTB and was not associated with increased fetal/early infant death. *** women enrolled in this study have different demographics
32
Trial of pessary in singletons - TOPS trial is ongoing
Population: women with singleton pregnancy and short cervix (cervical length less than 2cm) between 16 weeks and 23 weeks and 6 days . Intervention: pessary placement (arabis pessary) + vaginal progesterone Control: vaginal progesterone Outcome: Delivery less than 37 weeks
33
Pessary and progesterone for preterm prevention in twin gestation with short cervix - PROSPECT trial is ongoing
Population: twin gestation with cervical length less than 3cm less than 24 weeks Intervention: pessary placement (arabin pessary) Control: placebo and vaginal progesterone Outcome: delivery before 35 weeks Conclusion: