Preterm labor resident survival guide: Difference between revisions

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==Dos==
==Dos==


*The content in this section is in bullet points.
*Healthy pregnancy habits such as good prenatal medical care, staying hydrated, avoiding smoking and alcohol, eating nutritious foods and taking prenatal vitamins may also help lower the risk of preterm labor.


==Don'ts==
==Don'ts==

Revision as of 16:29, 5 April 2021

Preterm labor Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:Preterm delivery, Premature labour, Early delivery, Premature birth, Premature labor, Pre term birth

Overview

Causes

Intra-amniotic infection so far has only been shown to cause preterm delivery.[1] The other factors are being associated based on reports by clinical, epidemiologic, placental pathologic, or experimental studies.Intra-amniotic infections can be subclinical. One in four preterm infants are born due to this cause.[2]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Preterm labor:

Abbreviations: BP: Blood pressure; RR=Respiratory rate; HR=Heart Rate, PROM= Premature rupture of membranes; AFV= Amniotic fluid volume

 
 
 
 
 
 
Pregnant woman comes with Preterm labor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take obstetric history :

❑ Date of last menstrual period?

❑ Estimated date of delivery.

❑ Confirm the gestational age, gravidity and parity.

❑ Check if this is a single or multiple gestation.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about previous obstetric history if she was previously pregnant :

❑ Ask about previous pregnancies including miscarriages and terminations.

❑ Length of gestation.

❑ Ask about mode of delivery.

❑ Ask if there was similar complaints during previous pregnancy?

❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history :

❑ Age of menarche

❑ Last menstrual period

❑ Is the menstrual flow normal? How many pads she has to use in a day?

❑ Is there any foul smell or colour change?

❑ How many days does the menstruation stay?

Contraceptive history for example oral contraceptives, intrauterine device

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform physical examination :

❑ A physical exam is done to assess firmness, abdominal tenderness, fetal size, and position.

❑ Perform cervical exam to identify asymptomatic cervical dilatation and effacement.

❑ Regular contractions before term gestational age associated with cervical change, pelvic pressure, menstrual like cramps, watery vaginal discharge, and lower back pain.

Lower back pain is present in normal pregnancy but if it occurs before term, it might be associated with impending preterm labor.

❑ If cervical dilatation is at least 2 or 3 cm at less than 34 weeks, then the patient is highly likely to deliver preterm.

❑ Transvaginal ultrasound may show short cervix( cervical length <25mm at 16-24 weeks of gestation).It can help to distinguish cervical effacement due to cervical insufficiency versus due to active labor.[9]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do the following tests:

❑ If there is any suspicion about PROM: perform speculum examination to visualize amniotic fluid passing from the cervical canal and pooling in the vagina. Fern and pH testing of the pooled vaginal secretions can indicate rupture of membranes. The pH of amniotic fluid is 7.1 to 7.3.

Fetal fibronectin test: Due to the breakdown of the cervical extracellular matrix, fetal fibronectin in released. It is specific but not a sensitive test. If the result is negative, it is strongly indicates that of an intact membrane, but if positive, it does not necessarily indicative of premature rupture of membranes.

❑ Rectovaginal group B streptococcal culture should be done.

Urine drug screen if mother has history of drug abuse.

❑ A urine culture because asymptomatic bacteriuria increases the risk of preterm labor.

❑ Tests for sexually transmitted infections.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 








 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Dos

  • Healthy pregnancy habits such as good prenatal medical care, staying hydrated, avoiding smoking and alcohol, eating nutritious foods and taking prenatal vitamins may also help lower the risk of preterm labor.

Don'ts

  • The content in this section is in bullet points.

References

  1. Romero R, Gómez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim YM (July 2001). "The role of infection in preterm labour and delivery". Paediatr Perinat Epidemiol. 15 Suppl 2: 41–56. doi:10.1046/j.1365-3016.2001.00007.x. PMID 11520399.
  2. 2.0 2.1 2.2 Romero R, Dey SK, Fisher SJ (2014). "Preterm labor: one syndrome, many causes". Science. 345 (6198): 760–5. doi:10.1126/science.1251816. PMC 4191866. PMID 25124429.
  3. Condon JC, Hardy DB, Kovaric K, Mendelson CR (April 2006). "Up-regulation of the progesterone receptor (PR)-C isoform in laboring myometrium by activation of nuclear factor-kappaB may contribute to the onset of labor through inhibition of PR function". Mol Endocrinol. 20 (4): 764–75. doi:10.1210/me.2005-0242. PMID 16339279.
  4. Wisborg K, Henriksen TB, Hedegaard M, Secher NJ (August 1996). "Smoking during pregnancy and preterm birth". Br J Obstet Gynaecol. 103 (8): 800–5. doi:10.1111/j.1471-0528.1996.tb09877.x. PMID 8760711.
  5. Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F (2018). "Effect of maternal age on the risk of preterm birth: A large cohort study". PLoS One. 13 (1): e0191002. doi:10.1371/journal.pone.0191002. PMC 5791955. PMID 29385154.
  6. Craigo SD (October 2011). "Indicated preterm birth for fetal anomalies". Semin Perinatol. 35 (5): 270–6. doi:10.1053/j.semperi.2011.05.011. PMID 21962626.
  7. Hossain R, Harris T, Lohsoonthorn V, Williams MA (December 2007). "Risk of preterm delivery in relation to vaginal bleeding in early pregnancy". Eur J Obstet Gynecol Reprod Biol. 135 (2): 158–63. doi:10.1016/j.ejogrb.2006.12.003. PMC 2726845. PMID 17207901.
  8. Gomez R, Romero R, Edwin SS, David C (March 1997). "Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection". Infect Dis Clin North Am. 11 (1): 135–76. doi:10.1016/s0891-5520(05)70347-0. PMID 9067790.
  9. O'Hara S, Zelesco M, Sun Z (August 2013). "Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques". Australas J Ultrasound Med. 16 (3): 124–134. doi:10.1002/j.2205-0140.2013.tb00100.x. PMC 5029998. PMID 28191186.


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