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PRETERM LABOR

This mind map is about PRETERM LABOR. Start to use a mind map to express and organize your ideas and knowledge right now.

Editado em 2020-09-28 08:07:18

Captain O Captain

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PRETERM LABOR

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PRETERM LABOR

Definition of Preterm labor

Gestational age 20-37 weeks

Contractions with cervical change

Epidemiology

Incidence 7-8% of deliveries

Differential Diagnosis

Gastrointestinal

Appendicitis

Constipation

Uterus

Uterine Fibroids

Placental Abruption

Urinary

Acute Cystitis

Pyelonephritis

Nephrolithiasis

Musculoskeletal

Abdominal wall strain

Symptoms

Keep a high index of suspicion

Contraction frequency does not predict risk

Symptoms do not predict risk

Pelvic pressure

Vaginal pain

Menstrual-like cramps

Backache

Vaginal Discharge or fluid leakage (see PPROM)

Vaginal Bleeding

Signs

Examine Cervix as soon as possible

Avoid cervical exam until labor if PPROM confirmed

Examine Uterus

Assess for Abruptio Placentae

Check for firm, tender uterus with minimal relaxation

Evaluation: Four key concerns

Determine if patient is in labor

Evaluate abdominal or Pelvic Pain

Distinguish preterm labor from preterm contractions

Determine if membranes are ruptured

See Labs below

Establish clear gestational age

Review Last Menstrual Period

Review Estimated Due Date

Review prior ultrasound dating

Does fundal height correlate with gestational age

Evaluate maternal and fetal health

Consider underlying injury or infection

Recent trauma

Vaginal infection

Urinary Tract Infection in pregnancy

Consider comorbidity

Gestational Diabetes

Pregnancy Induced Hypertension

Intrauterine Growth restriction

Oligohydramnios or Polyhydramnios

Evaluate fetal activity and fetal health

External Fetal Monitoring

Radiology: Obstetric Ultrasound

Fetal evaluation

Biophysical Profile

Amniotic fluid index

Placental location

Fetal Presentation

Estimated Fetal Weight (EFW)

Ultrasound Exam of Cervical Length

Efficacy of evaluation criteria

Evaluation criteria do not predict preterm delivery

Fetal Fibronectin

Uterine contraction frequency

Cervical Length assessment

These criteria however have Negative Predictive Value

No Cervical Length change and negative fibronectin

Suggests <10% chance of preterm delivery

References

Iams (2002) N Engl J Med 346:250

Management

See Preterm Labor Management

References

Iams in Gabbe (2002) Obstetrics p.755

Risk Factors predisposing to Preterm Labor

No associated risk factor in 50% of preterm labor

Tobacco abuse over 1/2 pack per day Cigarettes

Prior cervical cone biopsy

Pyelonephritis

Advanced cervical dilatation

Increased Uterine Size

Twin Gestation

Polyhydramnios

Low pre-pregnant weight (Body Mass Index <19.8)

Low socioeconomic status or poor nourishment

Prior preterm delivery

History spontaneous second trimester abortion

African American race

Uterine anomaly

Unicornuate uterus or bicornuate uterus

Uterine Fibroids

Diethylstilbestrol (DES) exposure in utero

Genitourinary Infection (40% of preterm births)

Urinary Tract Infection

Pyelonephritis

Asymptomatic Bacteriuria in Pregnancy

LBW infants

maternal UTIs

No effect on Preterm birth

Vaginal infections

Group B Streptococcus (PPROM)

Bacterial Vaginosis

N Engl J Med (1995) 333:1732

Sexually Transmitted Disease

Neisseria gonorrhoeae

Chlamydia trachomatis

Trichomonas vaginalis

Syphilis

Infections with possible risk

Ureaplasma urealyticum

Mycoplasma hominis

Labs

Evaluate for Rupture of Membranes

Nitrazine Testing

Ferning

Microscopy to evaluate Vaginitis

Saline wet preparation

KOH Preparation

Culture

Gonorrhea Culture

Chlamydia culture

Group B Streptococcus Culture (Todd Hewitt media)

Periurethral or outer-third of vaginal swab

Rectal swab

Urine Culture

Consider non-genitourinary sources of infection

Other Testing

Fetal Fibronectin

Reassuring if negative

Poor Positive Predictive Value

Urine testing

Urinalysis and Urine Culture

Urine Drug Screening

Fetal Lung Maturity Assessment

Indicated for 34 week gestation or greater