Preterm labor

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Preterm labor

  1. 1. PREVIOUS PTD / STL OR PRETERM CONTRACTIONS 17 P WEEKLY 16-36 USE OF Cervical Length & fFn
  2. 2. Previous PTD < 34 wks Second Trimester Loss ( 12-16wks) <ul><li>Defined as idiopathic PTD 16 TO 34 weeks Start 17 P @ 16 weeks continue until 36 completed weeks </li></ul><ul><li>If previous second trimester loss from 12-16 weeks these patients should be evaluated for cerclage. </li></ul><ul><li>Serial cervical lengths @ 16 weeks every 2 weeks UNTIL 24 0/7 WEEKS. If cervix is < 25 mm these patients benefit from cerclage up to 24 0/7 weeks . ( OWEN RCT 2009 AJOG) </li></ul><ul><li>CERVIVCAL LENGTH If 25-34 mm continue serial cervical lengths every 1 WEEK vs 2 weeks UNTIL 24 0/7 WEEKS </li></ul><ul><li>CERVICAL LENGTH If > 35 mm continue every two weeks until 24 0/7 weeks. </li></ul>
  3. 3. PTL TRIAGE IN SYMPTOMATIC PATIENTS TVS Cervical length& FfN <ul><li>CL </= to 15 mm the risk of preterm delivery is high enough with CL @ 15 mm or less that a negative fFn does alter management. Admission for PTL Tx OR Further observation @ a minimum </li></ul><ul><li>CL 16-20 If fFn is positive admit for PTL Tx OR Further observation @ a minimum. If fFn negative close f/u as outpatient @ least weekly is warranted based on an elevated risk of PTD in the next 1-2 weeks. Do GBS & Strongly Consider outpatient BMS </li></ul><ul><li>CL 21-25 If fFn is positive Do GBS & consider admit for PTL Tx OR may consider BMS as outpatient. If fFn negative close f/u as outpatient weekly is warranted based on an elevated risk of PTD in the next 2 weeks. </li></ul><ul><li>CL 26-30 If fFn is positive Do GBS & consider BMS as outpatient OR consider admit for PTL Tx OR consider discharge home with no treatment and f/u as below. If fFn negative f/u as outpatient @ least every other is warranted based on an elevated risk of PTD in the next 4 weeks. </li></ul><ul><li>CL > 30 mm The risk of PTD is low enough with CL alone that fFn is not clinically useful. Discharge home no change in outpatient visits. PTL Sx/Sx review only </li></ul>
  4. 4. PRETERM CONTRACTIONS PERSISTENT (</= q 5 > 2hrs) AND CLINICALLY SIGNIFICANT (painful) <ul><li>CL </= to 20 admit for PTL Tx </li></ul><ul><li>CL 21-25 with a + fFn consider admission for PTL Tx OR @ least further observation & Tx with PO Procardia </li></ul><ul><li>CL 26-30 with a + fFn may consider admission however further observation & Tx with PO Procardia may be the best alternative </li></ul><ul><li>CL > 30 Observation for Cervical change. Consider PO procardia </li></ul>
  5. 5. PO Procardia Stepwise Approach <ul><li>1.) If clinically used to facilitate exclusion of preterm labor: Administer 10 mg orally every 20-30 minutes for up to four doses ( titrated by BP and uterine response ).The duration of action of a single orally administered dose is up to six hours. Plasma concentration peaks in 30 to 60 minutes. </li></ul><ul><li>2.) If clinically used to facilitate exclusion of preterm labor with persistent contractions after above; (allow @ least 60 minutes from last PO 10 mg dose and validate no clinically significant effect on BP) Increase dose to 20 mg PO every 3-8 hours with a maximum daily dose of 180 milligrams. ( titrated by BP and uterine response) </li></ul><ul><li>3.) OR start with Initial 20 milligram dose followed by an additional 20 mg PO in 60 minutes . Thereafter follow dosage schedule in # 2 above </li></ul>

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