the fetus get the fetus out and go on with life preterm labor o Maternal

The fetus get the fetus out and go on with life

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the fetus get the fetus out and go on with life preterm labor o Maternal: situational o Fetal: activates fetal-placental labor pathways Uteroplacental insufficiency (HPN, Type I DM, drug abuse, smoking, ETOH) or need delivery because of their chronic condition (smoking have higher risk that the government has a black box warning on cigarettes) Lack of cervical integrity (injury, malformation) abnormal pap smear injury scrape cells damage cervix Short cervical length (25 mm or less) short may be incompetent and not stay shut; 40mm long—they measure at your first appt. Maternal demographics (age, race, SES, low pregravid weight) cant necessarily change low BMI high risk
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Elective procedure, 13-17 wks. Elective procedure in women done at the start of the second trimester at risk for preterm labor; i.e. naturally short cervix and want to make sure it doesn’t open too soon tie a suture to shut down your cervix and then at 37 weeks clip it because who cares if you deliver at that point Number 1 Associated Factor Previous preterm delivery 15-45% recurrence risk stop the first preterm baby you have so you wont be a mom wit recurrent preterm labors 1 preterm is 15%, by 3 its 45% What might help? Progesterone supplementation Makena—an IM injection which may prolong pregnancy Diagnosis: if cervical changes Fetal fibronectin sample (FFN) before cervical exam if contractions and a positive result, they will likely deliver in the next 7-14 days, so you would want to give them treatment for preterm labor; If having contractions but their test is negative, they aren’t likely to be someone who will deliver so you likely wouldn’t treat them for preterm labor Protein, present at junction of BOW & cx (“glue”); detected in vaginal secretions protein that glues the bag of water to the cervix, and if having cervical changes this protein is disrupted and falls into the vagina and we take a sample of this protein and see if its there—if it is youre likely to deliver in the next 7-14 days + test = likely deliver in 7-14 days Management: Tocolysis Breaking down birth Criteria: 6 contractions/hour, causing cervical changes
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Tocolytic agents: Dangerous, because the meds we use have a lot of side effects, so we need to balance risks and benefits, then we only do it if we have a viable fetus, and we are before 34 weeks gestation (after this point benefits aren’t worth the risk and this age baby will most likely only have mild lung problems); used to delay delivery for 48 hours to allow glucocorticoids/corticosteroids to go and work; IM meds (betamethasone and dexamethasone) to stop delivery for 48 hours which cross the placenta and enhance surfactant production in the fetus, so when it is born they are likely to have less respiratory distress syndrome o Magnesium sulfate (MgSO4) o Indomethacin (Indocin) o Nifedipine (Procardia) Only if benefits of tocolysis > risk from 23-34 weeks o Can’t do if maternal or fetal compromise Primary purpose: delay delivery for 48 hours, allow maximum benefit of glucocorticoids to RDS o
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