To Stitch or Not to Stitch
A 21yo G1P0 @ 23w0d presents to triage reporting vaginal pressure. On speculum exam, the cervix appears 3 cm dilated with taut membranes bulging.
Discuss counseling =)
Bed rest to prevent preterm birth?
nope!
bed rest is NOT recommended. only increases risk of VTE
What is the preterm birth rate for singleton pregnancies?
~8%.
(50% after preterm labor, 25% after PPROM, 25% medically indicated)
A 21yo G1P0 @ 20w0d presents to L&D triage because she noted blood on the toilet paper when wiping. As you are setting up for speculum exam, friable hemorrhoids are visualized. There is no blood in vaginal vault, cervix is non-erythematous, however is incidentally noted to be 2cm dilated. On digital exam, cervix is 2/0/-3, and no membranes on palpable.
Can consider physical exam indicated cerclage!
Pelvic rest after cerclage placement
Nope!
No evidence to support
What is the preterm birth rate for twin pregnancies?
~60%
(with 20% of these born <34wks)
A 30yo G3P0202 (prior SVD at 31wks, 32wks) @8w0d asks how early she shoud begin cervical length surveillance.
16w0d
A 31yo G2P0101 @ 16w0d reports malodorous vaginal discharge. Vaginitis panel is positive for Gardnerella Vaginalis. Would you treat her?
Yes... to eradicate BV!
(...BUT... not to decrease her risk of spontaneous preterm birth <37 wks)
98% !!
(~85% <34wks)
A 28yo G4P0303 @16w0d presents to her NT scan. She declines a TVUS, and is only amenable to transabdominal US. Below which transabdominally measured cervical length will you offer her an ultrasound indicated cerclage?
35mm or less
A 19yo G1P0101 is 3 wks postpartum from preterm SVD at 28wks in the setting of preterm labor. Antenatal history is significant for anorexia nervosa, tobacco use disorder, and compulsive exercising. Her BMI is 16.5. Doctor, what do you recommend to decrease her risk of recurrent preterm birth?
1. BMI >18.5
2. Smoking Cessation
3. Avoid short interval pregnancy (18 months)
Preterm birth rate among Black birthing people in comparison to White or non-Black Hispanic birthing people
its about 50% higher
(14.6% vs (9.4%, 10.1%, respectively)
A 24yo G1P0 @ 20w0d has a cervical length of 6mm on TVUS, performed at the time of her anatomy US.
ACOG: "insufficient data, possible benefit"
AJOG-MFM: "Among low-risk asymptomatic women with a very short cervix (≤10.0 mm) in the midtrimester of pregnancy, women treated with cerclage have an increased latency to delivery and a lower prevalence of preterm delivery than those treated with expectant management"
https://www.ajogmfm.org/article/S2589-9333(24)00222-2/abstract
IM Progesterone to prevent preterm birth in patients with history of preterm birth?
Intramuscular 17-OHPC is no longer recommended for the primary prevention of preterm birth in patients with a history of spontaneous preterm birth.
Which depth of excisions for CIN can increase risk of preterm birth?
Excisions greater than 15mm