PTL / PPROM

Question 1

Benefits of BMZ?

Answer 1

Reduces RDS, NEC, IVH, and neonatal morality

Question 2

Who is a candidate for rescue BMZ?

Answer 2

Less than 34 weeks
> 7 days from prior dose of steroids
Delivery expected within 7 days

**Max benefit seen 2-7 days after given

Question 3

With a hx of prior spontaneous preterm birth… when is progesterone indicated?

Answer 3

1. Hx of PTB
2. Singleton pregnancy
3. Shortened cervix < 2.5 cm at less than 24 wks

***Vaginal progesterone only

IM Progesterone no longer recommended

Question 4

Indications for cerclage placement?

Answer 4

1. Hx indicated “elective cerclage”
2. Ultrasound indicated
3. Exam indicated

Question 5

Who are the patients that are candidates for a hx indicated cerclage? When do you place it?

Answer 5

Prior documented cervical incompetence

Place at 12-14 wks

Question 6

Who are the patients that are candidates for an ultrasound indicated cerclage?

Answer 6

Pt w/ NO prior PTB:
- Based on CL at anatomy scan, and cervix is </= 10 mm… if </= 25 mm use vaginal progesterone instead

Pt w/ prior PTB:
- CL screening Q1-4 wks from 16-24 wks
- Cervix is < 25 mm at any point

Question 7

Who are the patients that are candidates for an exam indicated cerclage/ rescue cerclage?

Answer 7

• Impending pregnancy loss
• Usually < 10-11 mm CL or for dilation

Question 8

Who gets Magnesium?

Answer 8

Concern for delivery at < 32 weeks