What is Preterm Labour and Birth
Delivery before 370 weeks gestation and has an incidence rate of 7.8% in 2013
What is Preterm Birth
Preterm birth is a major cause of perinatal morbidity and mortality and is estimated to account for __% of neonatal mortality.
A. 50%
B. 60%
C. 75%
D. 90%
The mean length at 240 to 280 weeks is 34mm to 35mm.
What is the cervical length?
The probability of PTB increases when the length is less than 25mm to 30mm, in a singleton pregnancy, (20mm in twins).
What group of medications have been shown to prolong pregnancy for 48 hours or more. This is to provide a window of opportunity for administration of glucocorticoids.
What are the 2 medications that would be considered and what route?
It's definition is having regular uterine contractions with progressive cervical dilation and/or effacement at >200 and <370 weeks gestation
What is Preterm Labour
What medication has been shown to decrease the risk of PTB in singleton pregnancies under 340 wks with a shortened cervix (< 25mm)
What is Progesterone.
What are the various routes of administration?
It is a glycoprotein whose presence in cervicovaginal secretions before 340 weeks is associated with preterm labour and birth
What is Fetal Fibronectin
What are contraindications for tocolytics?
What are 5 risk factors for induced (iatrogenic) preterm birth?
What should be considered in patients with a cervix <25mm before 240 wks if they have a prior history of preterm birth or a prior hx of suspected cervical incompetence
What type of imaging is the gold standard for measuring cervical length?
Transvaginal Ultrasound
The increased use of antenatal steroids have reduced occurrence and consequences of complications of RDS with preterm births.
What are the names of the steroids that can be given if there is concern for PTL and/or PTB
What is Betamethasone and Dexamethasone.
What is the dosage/frequency?
What are 5 risk factors for spontaneous preterm labour?
Identify the 6 steps for an assessment of preterm labour
2) VS and FHS
3) Obtain urine for C+S
4) Evaluate labour - frequency, intensity, duration, changes with time,
5) Cervical Assessment - sterile speculum for FFN, ?PPROM, culture swabs for G+C, GBS (if not done yet)
- defer digital examination until after confirmation membranes are intact and there is no placenta previa
6) Evalutate lab results - CBC for leukocytosis
What type of therapy should be considered for imminent delivery at <336 weeks?
What is Magnesium Sulphate for Fetal Neuroprotection
What neonatal assessment should be considered if corticosteroids were given for late preterm delivery?
What is increased monitoring and glucose checks for hypoglycemia.
A 2016 study showed administration of betamethasone significantly reduced the rate of neonatal RDS. Neonatal hypoglycemia was more frequent.
The rate of MgSo4 loading dose
What is 4g IV over 30 minutes