PTL

Question 1

what is average fetal weight at 20 wks, 30 wk, 40 wks?

Answer 1

3600 g at 40 wks
1200 g at 30 wks
400 g at 20 weeks
(x3)

Question 2

what is the margin for error with by gestational age?

Answer 2

< 9 weeks: +/- 5 days
9-14 weeks: +/- 7 days
14-16 weeks: +/- 7 days
16-22 weeks: +/- 10 days
22-28 weeks: +/- 14 days
> 28 weeks: +/- 21 days

Question 3

neonatal suvival %: 24 weeks and 28 weeks?

Answer 3

30-50% survival at 24 weeks

90% survival at 28 weeks

Question 4

what are benefits of ANC?

Answer 4

• reduced risk of RDS, NEC, IVH, death

Question 5

what to give ANC?

Answer 5

• should be considered 23 weeks and up
• 24-37 weeks and delivery anticipated within 7 days
• repeat course if > 14 days since last dose and delivery anticipated within 7 days and before 34 weeks
• no evidence of improved outcomes for repeat courses with PPROM

Question 6

regimens of ANC?

Answer 6

• BMZ: 12 g x 2 q24 hours

- Dexamethasone: 6 g x 4 q12 hours

Question 7

NP magnesium- timing/benefits/regimen?

Answer 7

• 24-32 weeks EGA
• reduces risk of moderate- severe cerebral palsy by 50%
• protocol: 6 g bolus, then 2 gm/hr x 12 hours
• no repeat bolus if only 6 hrs elapsed between stopping and restarting
• restart for imminent delivery

Question 8

shortened but not dilated cervix in pt with no prior preterm birth history - what regimen do you give?

Answer 8

• vaginal progesterone
• 200 mg vaginal suppository
• or 90 mg gel

Question 9

what are tocolytic medications?

Answer 9

NSAIDs- indomethacin
Calcium channel blocker - nifedipine
Beta agonist therapy - terbutaline

Question 10

how long should tocolytic medications be used?

Answer 10

max 48 hours - no evidence for repeat doses of tocolytics or maintenance therapy

terbutaline not approved for outpt use- maternal effects and fetal behavioral deleterious effects

Question 11

side effects of each type of tocolytic?
fetal risks?
contraindications

Answer 11

NSAIDS

• side effects: nausea, gastritis, emesis
• fetal effects: DA closure, oligohydramnios, DV closure
• contraindications: gastric/peptic ulcer disease, severe renal disease, bleeding disorder or platelet dysfunction

Calcium channel blocker

• side effects: dizziness, flushing, headache, hypotension, suppression of heart rate/contractility
• fetal effects: none known
• contraindications: preload dependent heart lesions (aortic insufficiency), hypotension

Beta agonist

• side effects: tachycardia, tremor, hypotension, palpitations, hypokalemia, hyperglycemia
• fetal effects:
• contraindications: tachycardia, maternal sensitive heart disease, poorly controlled diabetes

Question 12

sample regimen of tocolysis?

Answer 12

indomethacin: 50 mg x 1, then 25 mg q6hr for total of 48 horus
nifedipine: 20 mg x 1, then 10 mg q6 hr for total of 48 hours

Question 13

what are contraindications to tocolysis?

Answer 13

• hemodynamically significant vaginal bleeding
• pre-eclampsia with severe features or eclampsia
• PPROM
• chorioamnionitis
• lethal fetal anomaly
• IUFD
• non-reassuring fetal heart tracing
• maternal contraindications to specific agents

Question 14

no hx of PTB. what CVL cut off and EGA cut off would you recommend vag prog?

Answer 14

< 20 mm, < 24 weeks EGA

Question 15

hx PTB, what can be done to prevent PTB in this pregnancy.

Answer 15

• CVL monitoring q2week from 16-23 weeks; cerclage if < 25 mm. If 25-29 mm, then go to q1week
• 17 OHP IM 250 mg q2week starting at 16 weeks until 36 weeks (any preterm birth)