Def of preterm labor
Cervical change associated with uterine contractions prior to 37 completed weeks and after 20 weeks.
In a nulliparous woman, what findings are sufficient to call preterm labor?
Uterine contractions along with 2-cm dilation and effacement of 80%
What are 4 RF for preterm labor?
- Previous preterm labor or birth
- cocaine abuse
- pyelonephritis (and UTI)
- abdominal trauma
- cervical length less than 25mm
* gonococcal cervicitis is strongly associated with PTL
What is workup for suspected preterm labor?
- history to asses for risk factors
- speculum exam to look for ruptured membranes
- serial cervical exams
- fFN and transvaginal U/S to assess cervical length
- UDS, UA, CBC, Tests for gonorrhea, culture for GBS, USG for fetal weight and presentation
What are the two mainstays of treatment for preterm labor?
- Tocolysis
2. steroid administration
At what GAs are tocolytic agents considered
Gestational age less than 34-35 weeks
At what GAs are steroids given?
Less than 34 weeks (between 24 and 34 weeks)
What are 4 tocolytic agents used
- Mag Sulfate
- Terbutaline
- Nifedipine
- Indomethacin
What are two side effects of magnesium
- Pulmonary edema
2. respiratory depression
What are three side effects of terbutaline? 3 contraindications?
- Pulmonary edema
- hyperglycemia
- hypokalemia
- contraindicated in HTN, seizure d/o, and arrhythmia
What are 4 side effects/ complications of nifedipine? What drug can these not be given with?
- pulmonary edema (not as much as with terbutaline)
- severe hypotension
- CHF
- MI
- do NOT use on someone on Mag, may cause dangerous hypotension
What is a major side effect of indomethacin? When then is it contraindicated?
Can cause closure of the ductus arteriosus–> pulmonary HTN and oligohydramnios
- cannot use in third trimester (after 27 weeks)
- scenario: women given into now has variable deucels on FH tracing
What two steroid agents are used?
- betamethasone (2 doses)
2. dexamethasone (4 doses)
benefits of steroid admin?
Reduce risk of RDS, IVH, NEC, neonatal death
What are 6 contraindications to tocolytic use?
- nonreassuring fetal status
- chorioamnionitis
- pre-e or ecampsia
- fetal demise
- fetal maturity
- maternal hemodynamic instability
What can be done to lower risk of PTL in women at high risk?
Weekly injections of 17a-hydroxyprogesterone caproate from 16 weeks to 36 weeks
*history of prior spontaneous preterm delivery
