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31 Cards in this Set
- Front
- Back
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a healthy 19 yo G1P0 at 29 weeks gestation complains of intermittent abdominal pain but denies LOF, has an unremarkable antenatal history
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The tocometer shows UCTx's every 3 minutes
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this is a case of preterm labor
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she is contracting regularly and showing crvical change before 37 weeks
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What is the next step in mgmt for this preterm labor?
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do tocolysis and get some steroids on board
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Why use antibiotics?
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they prolong latency and are propylactic for intra-amniotic infection
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How do you test vaginal fluid to confirm a rupture of membranes?
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fetal fibronectin
also ferning and nitrazaine |
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What is the cervical change in a nulliparous woman that would indicate labor?
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2 cm dilation
80% effaced |
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What is the big use of fetal fibronectin?
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it's good for predicting whether or not a patient will deliver within a week
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If the fetal fibronectin is negative, then
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you worr ymuch much less about them delivering early. it would be highly unlikely
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if the FFN is positive, then the likelihood of them delivering is quite high
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This would favor immediate tocolysis
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What is the time window for giving steroids again?
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24 to 34 weeks
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What are two contraindications to tocolysis for preterm labor?
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severe pre-eclampsia
and intra-amniotic infections With these two conditions you want them to just go normall |
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What are some of the possible causes of preterm labor?
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UTI
cervicitis bacterial vaginosis trauma abruption hydramnios multiple gestation |
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What would this look like if this girl was less than 20 weeks pregnant?
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it would look more like an inevitable abortion
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What is fibronectin exactly?
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it's some sort of intra-amniotic basement membrane protein
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What is considered a "short cervix?"
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less than 25 mm
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You can also see...
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cervical funneling where they have impingement of the amniotic cavity
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What % of pregnancies are complicated by preterm labor?
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11%
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What are some risk factors for PTL>?
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PPROM
Multiple gestation hydramnios previous preterm labor uterine anomalies hx of leep or cone knife biopsies cocaine African American race trauma pyelonephritis |
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so remember some of these weird ones
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UTI
African American uterine anomalies |
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what are some features of the workup for PTL?
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H&P
sterile spec exam to look for pooling digital cervical exam to look for change CBC urine drug screen for cocaine u/A to look for UTI GC/CT cultures |
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So as soon as you establish a PTL dx you then want to be asking why
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in this cse it could have been due to prior hx
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What are some options for tocolytics?
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MgSO4
Nifedipine- CCB Terbutaline- but this should be down the list Indocin- Dr. Jackson thinks it might be the best one |
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What are some side effects of the magnesium?
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you can toxically high levels where you see decreased DTRs, respiratory depression, pulm edema etc.
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Nifedipine has very similar side effect profile
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yep
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remember that a single pregnancy can only get ONE DOSE of steroids
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y
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What STI is most strongly associated with PTL?
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gonorrhea cervicitis
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is chlamydia associated with PTL?
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not really
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do you give tocolytics with suspected abruption?
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no no no
this greatly increases their chances of postpartum hemorrhage |
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Even SUSPECTEd abruption is basically
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a contraindication to tocolytics
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because what is the main problem giving PPH anyway
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uterine atony- so if you give tocolytics then the uterus is not going to contract down well
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o Dyspnea in a women with preterm labor is often from B agonist therapy giving pulm edema
o Goal in treating PTL: ID the cause, give steroids, and tocolysis o RDS is the most common cause of mortality in preemies o B agonist therpy- all sorts of SNS-driven side effects o Negative ffn assays virtually guarantee no delivery within the week o TVUS can indicate a shortened cervix less than 25 mm |
yep
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