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24 Cards in this Set
- Front
- Back
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Definition of preterm birth
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Birth completed at <37 weeks gestation
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Limit of viability
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24 weeks
Usually no problems after 32 weeks |
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Major morbidities in preterm infants
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Death
Respiratory distress syndrome Intraventricular hemorrhage Chronic lung disease Sepsis Necrotizing enterocolitis Retinopathy of prematurity |
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Etiology of preterm birth
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Spontaneous - secondary to preterm labor or premature rupture of amniotic membranes
Indicated - due to maternal or fetal indication |
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Risk factors for spontaneous preterm birth
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History of prior SPTD
Multiple gestations Fetal anomalies Uterine abnormalities Incompetent cervix Infections Placenta previa or abruption Extremes of age Ethnicity Social support |
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Racial and ethnic disparity in preterm births
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More in blacks
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Diagnosis of preterm labor
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Uterine contractions and cervical change
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Management of preterm labor
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Tocolytics to stop contractions for 24-48 hours - MgSO4, beta agonists, NSAIDs, calcium channel blockers, alcohol
Steroids |
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Effect of steroids
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Reduce death, IVH, RDS/CLD, sepsis, and NEC
Not efficacious after 34 weeks Effect wears off after 2-3 weeks Limit to 1 course due to concern over head circumference |
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Diagnosis of PPROM
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Cervicovaginal secretions - fern and nitrazine testing
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Management of PPROM
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Tocolytics
Antibiotics - improve time to delivery Steroids - up to 32 weeks Expectant management to 32-34 weeks, then deliver |
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Mode of delivery of preterm infants
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Okay to deliver vaginally
Use normal Ob indications |
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Definition of chronic HTN
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BP over 140/90 prior to 20 weeks or persistent 12 weeks postpartum
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Pre-eclampsia superimposed on chronic HTN
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CHTN with new onset proteinuria after 20 weeks
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Gestational HTN
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HTN without proteinuria in latter half of pregnancy
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Pre-eclampsia
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New onset HTN, proteinuria after 20 weeks gestation
Severe if CNS symptoms, liver injury, thrombocytopenia, severe HTN/proteinuria, or oliguria |
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Eclampsia
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Pre-eclampsia with seizures
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Importance of pre-eclampsia
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Associated with increased maternal and fetal morbidity
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Incidence of pre-eclampsia
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5-8% in US
Most are mild |
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Risk factors for pre-eclampsia
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Nulliparity
Prior pre-eclampsia Extremes of age Family history Chronic HTN or renal disease APLA CT disease DM High BMI Prolonged interpregnancy interval |
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Evaluation of pre-eclampsia
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Confirm diagnosis
Serial BP monitoring Check labs Assess fetal status Prevent seizures |
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Management of pre-eclampsia at term
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Deliver
Seizure prophylaxis |
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Management of pre-eclampsia remote from term
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Expectant management to 32-34 weeks
Deliver |
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Seizure prophyalxis
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MgSO4
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