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obstetric - gynecol STEP 2 > preterm labor, preterm rupture > Flashcards

preterm labor, preterm rupture Flashcards

1
Q

preterm labor - risk factors (strongest?)

A
  1. premature rupture membranes
  2. multiple gestation
  3. previous history of preterm labor (strongest)
  4. placental abruption
  5. maternal factors (uterine anatomical abn, infections, preeclampsia, intraabdominal surgery)
  6. IUGR
  7. short cervix length
  8. cervical srgery (cold knife conization)
  9. cigarette use
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2
Q

maternal factors that are associated with preterm labor

A
  1. uterine anatomical abnormalities (bicornate uterus)
  2. infections (chorioamnionitis)
  3. preeclampsia
  4. intrabdominal surgery
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3
Q

preterm labor - presentation

A
  1. contractions (abd pain, lower back pain or pelvic pain)

2. dilation of cervix

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4
Q

how can preterm labor be stopped (and how)

A

with tocolytics

slow the progresion of cervical dilation by decreasing uterine contraction

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5
Q

preterm labor evaluation

A

the fetus should be evaluated for:

  1. weight
  2. gestational age
  3. presenting part (cephalic vs breech)
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6
Q

circumstances in which preterm labor should not be stopped with tocolytics and delivery should occur

A
  1. maternal severe hypertension (preeclampsia/eclampsia)
  2. matenal cardiac disease
  3. maternal cervical dilation more than 4 cm
  4. maternal hemorrhage (abruptio placenta, DIC)
  5. fetal death
  6. chorioamnionitis
  7. 34-37 EGA + more than 2.500 grams.
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7
Q

preterm labor - corticosteroids (purpose, time)

A
  • betamethasone –> to mature fetus’ lungs
  • effects begin within 24h, peak at 48h, persist for 7d
  • they will decrease the risk of resp distress syndrome and neonatal mortality (increase surfactant)
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8
Q

preterm: corticosteroids vs tocolytics

A

when steroids are administrated, a tocolytic should follow to allow time for steroid to wotk

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9
Q

tocolytics - drugs

A
  1. calcium channel blocker

2. terbutaline (b-adrenergic –> myometrial relaxation)

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10
Q

tocolytics - terbutaline mechanism of action and SE

A

b-adrenergic –> myometrial relaxation

increase maternal HR –> palpitations + hypotension

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11
Q

preterm labor management regarding time

A
  • less than 32 wks: betamethasone, tocolytics, MgSO2, penicillin
  • 32 - 33,6: betamethasone + tocolytics + penicillin
  • 34 and more: +/- betamethasone, penicillin
    MgSO4: fetal neuroprotextion
    Penicillin if strep + or unknown
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12
Q

preterm labor - definition

A

regular contractions before 37 wks that cause cervical dilation and/or effacement

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13
Q

Premature rupture of the membranes presentation

A

gush of fluid from vagina before 37 weeks

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14
Q

premature rupture of the membranes - diagnostic test

A

sterile speculum examination should confirm the fluid as amniotic fluid:

  1. fluid is present in posterior fornix
  2. fluid turns nitrazine paper blue
  3. when placed on slide and allowed to air dry fluid has ferning pattern
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15
Q

Premature rupture of the membranes can happen at …(time) / when it becomes problem

A
  • at any time throughout time

- it becomes the biggest problem when the fetus is preterm or with prolonged rupture of membranes

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16
Q

prolonged rupture?

A

the labor starts more than 18 h before delivery

17
Q

Premature rupture of the membranes leads to:

A
  1. preterm labor
  2. cord prolapse
  3. placental abruption
  4. chorioamniotis
18
Q

management of preterm prelabor rupture of membranes

A
  • 34-37 wks: antibiotic +/- corticosteorids. delivery
  • less than 34: signs of infection or fetal compromise:
    NO: antibiotics, corticosteroids, surveillance
    YES: antibiotics, corticosteroids, delivery, magnesium if less than 32
19
Q

1st step in evaluating the risk of preterm labor

A

transvaginal U/S measurement of cervical length in the 2nd trimester –> short cervical length is a strong predictor for preterm labor

20
Q

Preterm birth prevention

A

history of preterm labor?
NO –> Transvaginal U/S: If normal cervix then routine prenatal care. If short then vaginal progesterone
YES –> progesterone injection + Transvaginal U/S: if normal cervic then serial transvaginal U/S until 24 wks. If short then Cerclage, serial transvaginal U/S until 24 wks

21
Q

fetal fibronectin

A

high until 20 weeks, low during the mid-second and 3rd trimester –> increased again at term, when contractions disrupts the decidual-chorionic interface –> elevated level prior to term are used as indicator for increased risk of preterm labor

obstetric - gynecol STEP 2 (22 decks)

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