Pre-term Birth

Question 1

Leading cause of neonatal mortality in US

Answer 1

Preterm birth

Question 2

Preterm labor

Answer 2

Regular uterine contractions before 37 wks resulting in cervical change

Question 3

Preterm delivery risk factors

Answer 3

Hx of preterm delivery
African American
35 y/o
Low socioeconomic status
Tobacco use
Poor or excessive weight gain/low BMI
Abnormalities of AFV/oligo or poly
Multiple gestation, previa, abruption

Question 4

Best intervention for preterm labor

Answer 4

Administration of corticosteroids for women at risk for delivery b/w 24 and 34 wks
Betamethasone

Question 5

Cervical length as a predictor

Answer 5

< 25mm at 22-24 weeks at 6x increased risk of delivery < 35wks
In symptomatic pt, > 30 mm reliably excludes dx of preterm labor

Question 6

Fetal fibronectin as predictor

Answer 6

Extracellular matrix protein that attaches fetal membranes to decidua
Not normally present between 22-37 weeks
Test for it around 22-24 weeks
Presence after 22 weeks is marker of disruption of decidual chorionic interface - markedly increased risk of delivery w/in 7-14 days of test

Question 7

Most important clinical characteristic of fFN

Answer 7

Negative predictive value

Sypmtomatic pt with negative fFN risk of delivery within 7-14 days is <1%

Question 8

What therapy is used with a prior hx of preterm labor?

Answer 8

17 alpha-hydroxyprogesterone caproate

Ain’t nobody got time to say that

Question 9

Only medication approved by FDA for tx of preterm labor

Answer 9

Ritodrine
Delays delivery 24-48 hours
Not widely used

Question 10

Magnesium sulfate AEs at higher doses

Answer 10

Deep tendon reflexes lost > 12 mg/dL
Respiratory depression > 14mg/dL
Cardiac arrest >18 mg/dL

Question 11

Magnesium sulfate antidote

Answer 11

1 gm calcium gluconate

Question 12

Pts in preterm labor should receive what prophylaxis?

Answer 12

GBS unless proven negative

Question 13

Most effective intervention to improve neonatal outcome

Answer 13

Corticosteroid therapy
Administered b/w 24-34 weeks
REPETITIVE DOSING NOT INDICATED
Betamethasone DOC
Dexamethasone as alternative

Question 14

PROM

Answer 14

Ruptured membranes prior to labor

Question 15

PPROM

Answer 15

Ruptured membranes prior to 37 weeks

Question 16

PROM etiology

Answer 16

Intraamniotic infection
Low socioeconomic status
Low BMI
Preterm CTX
Cigarette smoking
Uterine overdistention
Short CL
Cerclage
Cervical conization
Hx of prior PTD
Amniocentesis

Question 17

Expectant Management Preterm PROM

Answer 17

Delivery at or beyond 34 weeks
24-33 Weeks manage expectantly
Single course corticosteroid administration
Adjunctive antibiotic therapy - IV ampicillin/erythromycin 48 hours followed by oral amoxicillin/erythromycin 5 days; Intrapartum GBS prophylaxis