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the fetusget the fetus out and go on with lifepreterm laboroMaternal: situationaloFetal: activates fetal-placental labor pathwaysUteroplacental 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 injuryscrape cellsdamage cervixShort 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 changelow BMI high risk
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 soontie a suture to shut down your cervix and then at 37 weeks clip it because who cares if you deliver at that pointNumber 1 Associated FactorPrevious preterm delivery 15-45%recurrence risk stop the first preterm baby you have so you wont be a mom wit recurrent preterm labors1 preterm is 15%, by 3 its 45%What might help? Progesterone supplementation Makena—an IM injection which may prolong pregnancyDiagnosis: if cervical changesFetal 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 laborProtein, present at junction of BOW & cx (“glue”); detected in vaginal secretions protein thatglues 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 daysManagement: Tocolysis Breaking down birthCriteria: 6 contractions/hour, causing cervical changes
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 syndromeoMagnesium sulfate (MgSO4)oIndomethacin (Indocin)oNifedipine (Procardia)Only if benefits of tocolysis > risk from 23-34 weeksoCan’t do if maternal or fetal compromisePrimary purpose: delay delivery for 48 hours, allow maximum benefit of glucocorticoids to ↓RDSo