preterm labor and PPROM Flashcards

1
Q

what is preterm

A
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2
Q

what is mortality

A

75% of preterm mort.

50% of long term morbilit

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3
Q

3 causes of normal labor

A
  1. prog. withdrawal - maternal or fetal
  2. oxytocin init.
  3. decidual activiation - infection and inflammation
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4
Q

when does cervical effacement occur

A

4-8 weeks before labor

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5
Q

3 things we can do about preterm

A
  1. try to prevent
  2. try to stop labor
  3. minimize sequelae
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6
Q

what is evidence of risk factors

A

most associatied, not causative

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7
Q

what is biggest risk factor

A

previous preterm

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8
Q

4 demo graphics

A
  1. age
  2. race/ethnicity
  3. SES
  4. education
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9
Q

major lifestyle factor and others

A

smoking - dose response

  • BMI
  • substances
  • stress
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10
Q

infection risk facotrs

A

may be due to prostaglandin production

  • bacteruria
  • vaginal
  • periodontal (maybe not)
  • pyelo
  • pneumonia
  • malaria
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11
Q

what is multiple risk

A

17% are preterms

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12
Q

what is bleeding risk

A

1st tri bleeds associated with

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13
Q

3 cervical uterus factors

A

1 uterine anomaly - bicornate

  1. cervical insuff
  2. previous cervical procedure
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14
Q

1 reproductive facotr

A

short inter-preg. term

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15
Q

2 maternal medical risk facrtors

A
  1. anemia

2. thrombophilia

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16
Q

2 ways to diagnose preterm

A
  1. regular contractions that lead to dilatation (contractions alone not enough)
  2. when in doubt fetal fibronectin
17
Q

what is fetal fibronectin

A
  • trophoblastic protein
  • test to predict onset on preterm labor
  • good NEG predictive value
18
Q

2 ways to try to prevent

A
  1. hydration and rest

2. tocolysis

19
Q

what is tocolysis

A

meds to slow down

20
Q

what is aim of toco

A

no reduction in MandM, but try to be able to tranfer mom

21
Q

contras to toco

A
• Maternal medical conditions
– preeclampsia
• Chorioamnionitis
• Bleeding previa or abruption
• Intrauterine growth restriction
• Contraindications to specific agents
• Mature fetus
• Intrauterine fetal demise
• Imminent delivery
22
Q

toco agents

A
  1. nifedipine (Ca channel blocker)

2. indomethacin (PG synthetase inhib)

23
Q

3 agents we dont use for toco

A
  1. MgSO4
  2. Antocin
  3. ritodrine
24
Q

3 ways to try to reduce the sequqlae

A
  1. get to tert center with around the clock care
  2. avoid stresses in transport
  3. steroids
25
when to give ABs
for GBS | - no effect on preterm, but prevent sepsis
26
what is steroid effects
no risks to mom or bb | - good for lungs
27
2 steroids
1. IM betamethasone | 2. IM dexamethasone
28
what is use of MgSO4
reduce risk of cerbral palsy
29
4 keys to preterm delivery
1. experienced personnel 2. close to neonatal resuscitations 3. mode basd on indications 4. delay the cord clamping
30
what is PPROM
Preterm premature rupture of | membranes
31
poss. cons. of PPROM (3)
1. prematurity 2. sepsis 3. pulm. hypoplasia
32
risks for PPROM
``` • Idiopathic • Infection • Following cerclage or amniocentesis • Uterine abnormality • Cervical insufficiency • Previous cervical surgery/conization • Trauma • Risk factors: – History of PPROM – Lifestyle: drugs, smoking, stress, nutrition ```
33
ways to diagnose PPROM
1. Hx of vaginal leak 2. speculum exam - ferning, Ph is high, flow of fluid
34
2 gen options for pre-viable PPROM
1. extend latent phase | 2. terminate
35
treatments for PPROM of up to 34 weeks (2)
1. one course steroids 2. ABs 3. no tocolysis