preterm labor and PPROM

Question 1

what is preterm

Question 2

what is mortality

Answer 2

75% of preterm mort.

50% of long term morbilit

Question 3

3 causes of normal labor

Answer 3

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

Question 4

when does cervical effacement occur

Answer 4

4-8 weeks before labor

Question 5

3 things we can do about preterm

Answer 5

1. try to prevent
2. try to stop labor
3. minimize sequelae

Question 6

what is evidence of risk factors

Answer 6

most associatied, not causative

Question 7

what is biggest risk factor

Answer 7

previous preterm

Question 8

4 demo graphics

Answer 8

1. age
2. race/ethnicity
3. SES
4. education

Question 9

major lifestyle factor and others

Answer 9

smoking - dose response

• BMI
• substances
• stress

Question 10

infection risk facotrs

Answer 10

may be due to prostaglandin production

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

Question 11

what is multiple risk

Answer 11

17% are preterms

Question 12

what is bleeding risk

Answer 12

1st tri bleeds associated with

Question 13

3 cervical uterus factors

Answer 13

1 uterine anomaly - bicornate

2. cervical insuff
3. previous cervical procedure

Question 14

1 reproductive facotr

Answer 14

short inter-preg. term

Question 15

2 maternal medical risk facrtors

Answer 15

1. anemia

2. thrombophilia

Question 16

2 ways to diagnose preterm

Answer 16

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

Question 17

what is fetal fibronectin

Answer 17

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

Question 18

2 ways to try to prevent

Answer 18

1. hydration and rest

2. tocolysis

Question 19

what is tocolysis

Answer 19

meds to slow down

Question 20

what is aim of toco

Answer 20

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

Question 21

contras to toco

Answer 21

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

Question 22

toco agents

Answer 22

1. nifedipine (Ca channel blocker)

2. indomethacin (PG synthetase inhib)

Question 23

3 agents we dont use for toco

Answer 23

1. MgSO4
2. Antocin
3. ritodrine

Question 24

3 ways to try to reduce the sequqlae

Answer 24

1. get to tert center with around the clock care
2. avoid stresses in transport
3. steroids

Question 25

when to give ABs

Answer 25

for GBS

- no effect on preterm, but prevent sepsis

Question 26

what is steroid effects

Answer 26

no risks to mom or bb

- good for lungs

Question 27

2 steroids

Answer 27

1. IM betamethasone

2. IM dexamethasone

Question 28

what is use of MgSO4

Answer 28

reduce risk of cerbral palsy

Question 29

4 keys to preterm delivery

Answer 29

1. experienced personnel
2. close to neonatal resuscitations
3. mode basd on indications
4. delay the cord clamping

Question 30

what is PPROM

Answer 30

Preterm premature rupture of

membranes

Question 31

poss. cons. of PPROM (3)

Answer 31

1. prematurity
2. sepsis
3. pulm. hypoplasia

Question 32

risks for PPROM

Answer 32

• 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

Question 33

ways to diagnose PPROM

Answer 33

1. Hx of vaginal leak
2. speculum exam
   - ferning, Ph is high, flow of fluid

Question 34

2 gen options for pre-viable PPROM

Answer 34

1. extend latent phase

2. terminate

Question 35

treatments for PPROM of up to 34 weeks (2)

Answer 35

1. one course steroids
2. ABs
3. no tocolysis