ptl & prom Flashcards
preterm labor is…
labor occurring -> 20 to 37 - 1 cm (+ progressive!)- effacement 80% or morecontractions are regular, painful and:- 4 per 20 min OR - every 10 minutes OR - less for at least 30 minutesrisk factors often unknown; assess for/screen = VITAL
late preterm birth
34 - 36 weeks gestation
moderately preterm birth
32 - 34 weeks gestation
very preterm birth
prior to 32 completed weeks gestation
extreme preterm birth
at or less than 25 weeks gestation
low birth weight
=
moderately low birth weight
= 1500 to 2499 g (3.3 to 5.5lb)
very low birth weight
=
respiratory distress syndrome
- not enough surfactant cells due to immaturity- decreased pulmonary gas exchange, leading to retention of carbon dioxide (increased arterial PCO2). Most common neonatal causes:- prematurity- perinatal asphyxia- maternal diabetes mellitus- hyaline membrane disease (HMD)
intraventricular hemmorhage
blood vessels of infant so fragile, any venous pressure can lead to bleed
bronchopulmonary dysplasia
iatrogenic; trauma caused by mechanical ventilation,
necrotizing enterocolitis
etiology/process unknown!- blood shunted from gut could be caused by overgrowth of bacteria before natural flora established- possible tube feeding formula = substrate for bacterial growth- perforation of gut
hyperbilirubinemia
?
intrauterine growth restriction (IUGR)
?
fetal compromise
?
intrauterine fetal demise (IUFD)
?
medically indicated preterm birth is…
…indicated for maternal or fetal reasons including: preeclampsia, diabetes, placenta previa, abruptio placenta, IUGR, fetal compromise, IUFD…accounts for 25% of preterm births
PTL: demographic risk factors
…maternal age = 35…highest incidence in non-hispanic black women…low SES, unmarried, low education level
PTL: behavioral/lifestyle risk factors
smoking, alcohol/substance abuse, DV, lack of social support, stress, physically demanding work conditions
PTL: medical risk factors
…infection/inflammation (only causality known FOR SURE)chorioamnionitis, UTI, genital tract, periodontal…autoimmune disorders…thromboembolic disorders…renal, cardiovascular diseasemom may be physically incapable of carrying baby…anemia
PTL: obstetrical/reproductive risk factors*
- previous preterm birth* multifetal pregnancy* cervical, uterine abnormalities- short interval between pregnancies- PROM- abruption- vaginal bleeding- anemia- fetal anomalies
PTL: common symptoms
- often subtle, intermittent- may be present up to 2 weeks before hospital admit- persistent, low, dull backache- vaginal spotting- pelvic pressure- abdominal tightening, cramping- increased vaginal discharge- uterine contactions (q10” for 30” or less = CALL PROVIDER)
PTL: definitive diagnosis
persistent uterine contractions AND documented cervical changeOReffacement >= 80% (subjective)ORdilation > 1 cm
fetal fibronectin
- glycoprotein produced by chorion found at junction of chorion (fetal membrane) and decidua (uterus)- better predictor of who WILL NOT go into PTL; negative = PTL very unlikely
chorioamnionitis
?
PTL: treatment
…no specific, standardized plan of care…patient education, bed rest, IV fluids, tocolytics/corticosteroids
PTL: management
initial assessment/observation- change in dilation (recheck, same provider preferred)- monitor contractions- electronic fetal HR monitor- US
PTL: tocolytic agents
beta mimetic adrenergic agents are US GOLD STANDARD: - ritodrine (only FDA approved tocolytic, but removed from market after PE documented post-use)- terbutalinealso- magnesium sulfate- indomethacin- nifedipineprimary goal of administration: get steroids in!
PTL: corticosteroids
stimulate fetal lung maturation by inducing production/release of surfactant; single course recommended between 24 and 34 weeks- betamethasone, dexamethasone- optimal benefit 24 hours after first injection
PTL: antibiotics
penicillin; prophylaxis for Group B Strepinfection is preterm baby’s worst enemy
PTL: progesterone
- weekly administration starting at 16 to 20 weeks- for women with previous PTL hx- reduces risk as much as 33%- exact MOA unknown
3 interventions proven to reduce perinatal morbidity & mortality
- transport of women to facility with NICU- administration of glucocorticoids- treatment with antibiotics for gbs
cervical cerclage (why & what)
- for cervical insufficiency
cervical insufficiency
aka incompetence; dilation and shortening fo cervix prior to 37 weeks in the absence of contractions- typically painless- responsible for 20% of late 2nd trimester loss
prophylactic cerclage (when)
12 to 14 weeks
rescue cerclage
when cervical changes already detected
premature rupture of membranes (prom)
rupture of fetal membranes with release of amniotic fluid more than one hour prior to onset of labor - 50% will go into labor within 24 hours
preterm prom (pprom)
prom before 37 weeks- 1/3rd of preterm births
prolonged prom
?
pulmonary hypoplasia
?
pprom assessment: fern
?
pprom assessment: pool
?
pprom assessment: nitrazine
?
pprom assessment: ideal
93% accuracy with combo fern/pool/nitrazine
pprom assessment: infection
maternal tachycardia, uterine tenderness, fever, foul smelling fluid
nst
non-stress test?
bpp
biophysical profile?
pprom tx: labor inhibition
- prolong pregnancy, no benefit to neonatal outcome- can be used in pts
pprom tx: corticosteroids
betamethasonedexamethasone
expectant management
?
conservative management
?
