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Gyne > Preterm Labor > Flashcards

Preterm Labor Flashcards

1
Q

What is preterm birth

A

After 20wks and before 37 completed

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2
Q

Upon which does the mortality and morbidity depend on in preterm labor

A

Gestational age

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3
Q

What are the risk factors for preterm labor

A 
1- prev
2- poor placenta implantation 
3- iatrogenic (pre-eclampsia\IUGR\thrombo)
4- ART (AVF) 
5- maternal (advanced age, disease, obesity)
6- multiple gestations 
7-  rupture of membrane 
8- APH & cervical incompetency 
9- stress
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4
Q

What is early pre-term

A

<32 weeks

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5
Q

What is the most common factor for preterm

A

Unkown

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6
Q

What is the most known common factor for preterm

A

infection

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7
Q

Name infection that is associated w\preterm

A

BV

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8
Q

How does infection affecting the cervicx cause preterm labor

A

Disrupt the fetal membrane > release FFN and preterm labor

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9
Q

What is a placental cause of preterm labor

A
  • abnornal trophoblast invasion

- progestrone dysregulation

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10
Q

How does stress induce preterm labor

A

Cortisol and catecholamine

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11
Q

How does uterine stretch cause preterm labor and where do we commonly see it

A

Cause failure of parathyroid related protein PTrP

We see it in: multiple gestation, polyhydraminos & macrosomia

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12
Q

What is the role of PTrP?

A

Keeping the myometrium muscles relaxed

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13
Q

What are the most common causes of preterm labor (spont, or, induced)

A

Spontanous

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14
Q

Name iatrogenic causes of preterm birth

A

Placenta previa or abruptio, fetal growth restriction, multiple gestation, pre-eclampsia

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15
Q

How to predict the chance of preterm labor

A

Fibronectin test

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16
Q

What does the fibronectin test indicate

A

Labor could happen within 7 days

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17
Q

What is the diagnostic criteria for preterm labor

A
  • uterine contraction (4 per 20\8 per 60)

- cervical changes (80% effaced or 2cm dilated)

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18
Q

What is the investigation that you’d like to do for patients undergoing preterm labor

A

CTG, US, HVS, baseline investigation + cervical assessment

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19
Q

What is the initial management that you’d like to do for these patients with preterm labor

A

1- Bed rest, hydration
2- antibiotics
3- steroid (+- tocolytics)

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20
Q

Is bed rest actually affective in preterm labor

A

Yes 20% the contraction will stop

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21
Q

What are the AB that are usually given in preterm labor

A

Ab for 48 hours

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22
Q

What is the role of steroids in preterm

A

Induce lung maturity

23
Q

Why do we give tocolytics in preterm labor

A

1- give time for transfer
2- give time for steroid to work

(Postpone labor for 48 hours)

24
Q

What are the uterine tocolytic agents used in preterm labor

A

PCOS NO bleeding

  • PGs
  • Cyclooxygenase (indomethacin)
  • Sulfate
  • Nifedipine
  • oxytocin antagonist
25
Q

What is the maximum side effect for the

  • mother
  • fetal
A
  • B-blocker (tribtualine)

- indomethacin

26
Q

What is the most commonly used tocolytic

A

Nefidipine

27
Q

What tocolytic medication should be avoided\indicatedfor cardiac patients

A

avoided: Nefidepine
Indicated: atopan

28
Q

What is the role of magnesium sulfate

A

Lung maturation, prevent eclampsia, neuroprotection

29
Q

What is the maternal complication in preterm

A
  • Retained plcacenta

- need of c\s

30
Q

What is the risk on fetus for preterm

A

RDS, patent ductus, retinopathy, hypoglycemia and thermia, anemia

31
Q

What medication stimulate the closuer of ductus arteriosus

A

Indomethacin

32
Q

What is the definition of premature rupture of membrane?

A

Spontanous rupture of membrane (amniorrhexis)before onest of labor

  • preterm premature: before 37 weeks
33
Q

What are the causes for premature rupture of membrane

A
  • unknown
  • vaginal\cervical infection
  • abn membrane physiology (apoptosis 2ndary to oxidative stress)
  • cervical insufficiency
  • nutritional def.
34
Q

How to diagnose PROM

A

1- hx of vaginal loss of fluid
2- amniotic fluid in vagina
3- speculum + US

35
Q

What are the tests for sterile examination to diagnose PROM

A

Pooling - ferning - nitrazine - amnisure

36
Q

What is pooling test?

A

Leakage by vision

37
Q

What is fening test

A

Swab from posterior vernix

38
Q

What is nitrazine test?

A

PH test, if alkaline this is either sperm or leaking of amniotic fluid

39
Q

What is amnisure

A

Alpha-microglobulin-1

40
Q

What are the US findings if there’s PROM?

A

AFI<5cm

41
Q

What are the ddx for PROM

A

Urinary incontience, leucorrhea (discharge) - loss of mucus plus - vaginal infection or secretion

42
Q

What is the property of the amniotic sac and fluid

A

Sac: mechanical protection against infection
Fluid: bacteriocidal effect

43
Q

Is intact membranes an absolute barrier to infection?

A

No, there’s hematogenous spread of infections

44
Q

What is the workup for PROM

A

Same as preterm labor except add th amniotic sample for culture & sensitivity

45
Q

How to treat PROM

A

Same as PTL

46
Q

When to deliver patient with PROM and when to provide medications

A

According to GA

  • > or equal to 36
  • <36
47
Q

What if there’s PROM with no contraction >or equal to 36

A
  • Induction of labor within 6-12hrs

- if no evidence of infection & cervix isn’t favorable > in 24hrs

48
Q

What is the management of PPROM <36

A
  • if stable, no contraction & infection: expectant until lung maturation.
  • antibiotics
  • look for chorioaminitis
49
Q

How to diagnose chorioaminitis?

A
  • Temp>= 38 w\no infection
  • fetal tachycardia
  • uterine tenderness & irritability on CTG
  • leukocytosis
50
Q

What is the Ab used in PPROM?

A

IV erythromycin 48hrs then PO 5x

51
Q

When is it applicable to manage these patients as outpatient

A
  • no infection
  • normal AFI
  • well educated
  • vertex presentation
  • closed cervix
  • home instructions
52
Q

What are the home instructions to give to patients with PPROM

A

1- no coital activity or PA
2- monitor temp because PROM=infection
3- weekly hospital visit\CTG\ growth

53
Q

What if there’s chorioaminitis in PROM?

A

Immidiate delivery is indicated

54
Q

Is it recommended to give tocolysis to patients with chorioaminitis?

A

Not recommended

Gyne (18 decks)

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