preterm labor and PPROM Flashcards
what is preterm
what is mortality
75% of preterm mort.
50% of long term morbilit
3 causes of normal labor
- prog. withdrawal - maternal or fetal
- oxytocin init.
- decidual activiation - infection and inflammation
when does cervical effacement occur
4-8 weeks before labor
3 things we can do about preterm
- try to prevent
- try to stop labor
- minimize sequelae
what is evidence of risk factors
most associatied, not causative
what is biggest risk factor
previous preterm
4 demo graphics
- age
- race/ethnicity
- SES
- education
major lifestyle factor and others
smoking - dose response
- BMI
- substances
- stress
infection risk facotrs
may be due to prostaglandin production
- bacteruria
- vaginal
- periodontal (maybe not)
- pyelo
- pneumonia
- malaria
what is multiple risk
17% are preterms
what is bleeding risk
1st tri bleeds associated with
3 cervical uterus factors
1 uterine anomaly - bicornate
- cervical insuff
- previous cervical procedure
1 reproductive facotr
short inter-preg. term
2 maternal medical risk facrtors
- anemia
2. thrombophilia
2 ways to diagnose preterm
- regular contractions that lead to dilatation (contractions alone not enough)
- when in doubt fetal fibronectin
what is fetal fibronectin
- trophoblastic protein
- test to predict onset on preterm labor
- good NEG predictive value
2 ways to try to prevent
- hydration and rest
2. tocolysis
what is tocolysis
meds to slow down
what is aim of toco
no reduction in MandM, but try to be able to tranfer mom
contras to toco
• Maternal medical conditions – preeclampsia • Chorioamnionitis • Bleeding previa or abruption • Intrauterine growth restriction • Contraindications to specific agents • Mature fetus • Intrauterine fetal demise • Imminent delivery
toco agents
- nifedipine (Ca channel blocker)
2. indomethacin (PG synthetase inhib)
3 agents we dont use for toco
- MgSO4
- Antocin
- ritodrine
3 ways to try to reduce the sequqlae
- get to tert center with around the clock care
- avoid stresses in transport
- steroids
when to give ABs
for GBS
- no effect on preterm, but prevent sepsis
what is steroid effects
no risks to mom or bb
- good for lungs
2 steroids
- IM betamethasone
2. IM dexamethasone
what is use of MgSO4
reduce risk of cerbral palsy
4 keys to preterm delivery
- experienced personnel
- close to neonatal resuscitations
- mode basd on indications
- delay the cord clamping
what is PPROM
Preterm premature rupture of
membranes
poss. cons. of PPROM (3)
- prematurity
- sepsis
- pulm. hypoplasia
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
ways to diagnose PPROM
- Hx of vaginal leak
- speculum exam
- ferning, Ph is high, flow of fluid
2 gen options for pre-viable PPROM
- extend latent phase
2. terminate
treatments for PPROM of up to 34 weeks (2)
- one course steroids
- ABs
- no tocolysis
