UW preterm labor 03-24 (2)

Question 1

what is considered preterm labor?

Answer 1

<37 weeks

It regular contractions causing cervical change at <37 weeks gestation with intact membranes

Question 2

algo. Preterm labor –> what evaluate?

Answer 2

maternal instability
intrauterine infection
fetal distress/demise

Question 3

algo. Preterm labor –> YES maternal instability/intrauterine infection/fetal distress/demise –> next step?

Answer 3

IMMEDIATE DELIVERY

Question 4

algo. Preterm labor –> NO maternal instability/intrauterine infection/fetal distress/demise –> next step?

Answer 4

Mx according to gestational age

Question 5

algo. 32 - 34 weeks (moderate preterm). 3 points

Answer 5

Corticosteroids
Penicillin if GBS positive or unknown
Tocolytics - first line is nifedipine

Question 6

algo. <32 weeks (very preterm) . 4 points

Answer 6

Corticosteroids
Penicillin if GBS positive or unknown
Tocolytics - first line is indomethacin
MgSO4

Question 7

algo. 34-37 weeks (late preterm). 2 points?

Answer 7

+/- corticosteroids
Penicillin if GBS positive or unknown

Question 8

why need MgSO4 <32 w?

Answer 8

sulfate to decrease the risk of cerebral palsy, which is highest in infants delivered at <32 weeks gestation. The neuroprotective mechanism of magnesium sulfate likely is due to stabilization of fetal neuronal membranes in utero or anti-inflammatory effects.

Question 9

whats about MgSO4 >=32w?

Answer 9

not administered

Question 10

Why indometacin first line <32w?

Answer 10

Because of its high efficacy and few maternal adverse effects; as gestational age increases, however, indomethacin poses greater fetal risks (eg, premature closure of the ductus arteriosus).

Question 11

Why nifedipine 32-34w?

Answer 11

Indomethacin poses greater fetal risks (eg, premature closure of the ductus arteriosus). Therefore, nifedipine is preferred between 32 and 34 weeks gestation

Question 12

Penicillin to prevent vertical transmission of group B Streptococcus (GBS)
REQUIRES IN ALL PRETERM PATIENTS

Answer 12

.

Question 13

Corticosteroids (eg, betamethasone) to promote fetal lung maturity.

Answer 13

.

Question 14

what about tocolytics at ≥34 weeks gestation?

Answer 14

not recommended to temporarily halt preterm contractions and delay labor because the risks of indomethacin (eg, oligohydramnios, closure of the ductus arteriosus) and nifedipine (eg, maternal hypotension/tachycardia) outweigh the neonatal risks of preterm delivery

Question 15

if patient 35 w + has active contractions, stable. Mx?

Answer 15

patients in preterm labor at ≥34 weeks gestation who have no contraindications to vaginal delivery (eg, placenta previa), receive expectant labor management.

Question 16

patients may benefit, but use of corticosteroids after 34 weeks gestation is not universal.

Answer 16

.