Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
OB Preterm & PROM
Preterm Labor and Premature Rupture of Membranes
| Question | Answer |
|---|---|
| preterm labor | defined as regular ctx’s AND cervical dilation before 37-wks |
| PROM | rupture of membranes before onset of labor. if before 37-wks is referred to as PPROM (preterm premature rupture of membranes) |
| Leading causes of preterm deliveries | Preterm labor (PTL) and preterm premature rupture of membranes (PPROM) are the main leading causes of preterm deliveries |
| Leading cause of developmental disability in children | Pre-term delivery. including cerebral palsy and mental retardation. important cause of blindness and chronic lung problems |
| National Average of pre-term births | 12.1%. AA higher at 17% |
| Potential Risk factors for Preterm labors | Smoking, AA, maternal age: youngest and oldest, Stressful social factors (poverty, poor housing, crime). Underlying biological mechanisms poorly understood. |
| Biggest predictor for having a preterm delivery is | having previous preterm delivery |
| Screening Predictors of the risk of PTD | Cervical length measured by US (may be predictive), Biochemical meausre: fetal fibronectin (if FFN is negative, it is most likely you will not have a PTD, Negative predictive value is high. Positive Predictive value is less useful, on the fence) |
| Cervical Length as a Predictor of PTD | Reliable and reproducible. Cervical shortening associated with preterm delivery. However, very variable predictive value. Not recommended alone |
| Treatment with Progesterone in pregnant women with previous PTD showed | decreases in PTD, less fetal problems. So far, studies are in high risk women |
| Role of tocolytic agents in PTL | Efforts to treat ♀ with tocolytic agents for premature labor after it has been diagnosed have had minimal success and have NOT resulted in improved perinatal outcomes. May prolong gestation 2-7 days (give steroids to improve lung maturity) |
| Tocolytic agent that has an AE of cardiac arrhythmias | Beta-mimetic |
| Tocolytic agent that has an AE of pulmonary edema? | Magnesium Sulfate (most widely used) |
| Tocolytic agent that has an AE of maternal hypotension | Calcium Channel Blockers (stops contractions. Data is good) |
| Antenatal steroids Benefits | Benefits - significant reduction in the risk of respiratory distress syndrome (RDS), mortality and intraventricular hemorrhage (IVH) |
| Antenatal Steroids: who should get them? | Should be given to all women at risk for preterm delivery between 24-34 wks |
| management of PTL: what does NOT work? | Bedrest, hydration, pelvic rest, antibiotics |
| PPROM | Preterm Premature Rupture of Membranes. Associated with PTD. 85% will enter PTL within 1 week. Intraamniotic infxn clinically evident in 13-60%. Placenta abruption occurs in 4-12%. Risk for pulmonary hypoplasia (if ROM<26weeks) |
| Development of lungs | is facilitated by swallowing, so if a women have PPROM, then the baby has nothing to swallow |
| PPROM Risk Factors | Intraamniotic infxn, prior hx, low SES, teenager, smoker, hx of STD, hx of cervical cerclage, uterine overdistention |
| Diagnosis/Evaluation of PPROM | Hx, Sterile Speculum Exam (pooling, ferning, nitrazine positive pH>6--will be false positive if recent sex of bleeding), vaginal/cervical cultures. NO digital exam, odor, tender belly, fever, tachycardia (infxn signs) |
| No steroids are given in PPROM if mom is less than __ weeks along | <24 weeks. |
| PPROM Management | Monitor CBC and vitals (temp), Daily fetal testing, Abx (7-day course) |
Created by:
ltm12