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Preterm Labor Case Pres 1
Preterm Labor Case Pres 1
Preterm Labor Case Pres 1
LABOR GROUP 2
Interns: Dr. Nikki Jill N. Bearis and Dr. Rosangela de Leon
Clerks
Cariño, Shaira; Carpio, Gabrielle; Celso, Karren;
Corral Bernadette Fatima, Descalzo, Regine Bernadette
Conde, Ma. Thelma Precy; Cosa, Michael Angelo; Karan Thakkar;
Kumar, Suraj; Mandaliya, Ajaybhai; Suruchi Dhillon; Singh, Priya;
Punadiya, Arati
IDENTIFYING
DATA
S.P. 15 y/o
CHIEF
COMPLAINT
● G1P0 labor pain
● 26 4/7 wks AOG
● Single
● Roman Catholic
● Marigondon,
Pio Duran
HISTORY OF
PRESENT
PREGNANCY
G1P0
4
PAST MEDICAL
HISTORY:
(-) asthma
(-) hypertension
(-) blood dyscrasia
(-) rheumatic heart disease
(-) history of drug allergy
(-) previous surgery
5
FAMILY HISTORY:
6
PERSONAL AND SOCIAL
HISTORY:
● # of SEXUAL PARTNERS: 2
● CONTRACEPTIVE: None
9
REVIEW
OF
SYSTEMS
GIT: GUT:
CARDIOVASCULAR: (-) diarrhea (+) frequent
(-) easy fatigability (-) constipation urination
(-) palpitations (+) Abdominal pain (-) no bloody urine
REVIEW
OF
SYSTEMS
Alert, awake,
not in cardiorespiratory distress
VITALS
BP: 100/60 mmHg HR: 114 bpm RR: 22cpm
HEIGHT / WEIGHT
133.5cm / 44 kg
BMI: 24.6
(NORMAL)
PHYSICAL EXAMINATION
HEENT
Anicteric sclerae, Pink palpebral conjunctiva, no eye discharge, pink nasal mucosa,
septum midline, no discharge, pinna complete, no bleeding nor discharge, no
cervical lymphadenopathy
HEART
Adynamic precordium, tachycardia, no murmur. no heaves nor thrills, PMI at 5th
ICS MCL
PHYSICAL
EXAMINATION
ABDOMEN
No scars, lesions.
Normoactive bowel sounds,
soft non tender
FH: 19cm FHT: 130s bpm
PHYSICAL
EXAMINATION
NEURO EXAM
Mental Status: Alert, relaxed, cooperative
Cranial Nerves: Intact
PELVIC EXAM
Normal external genitalia, parous
Cervix 3cm dilated; 80% effaced
Intact bag of water
Breech
Station -3
LABORATORY AND
DIAGNOSTICS CBC
URINALYSIS
Negative Protein
Negative Glucose
LABORATORY AND
DIAGNOSTICS
HBsAg: Non-reactive
RPR: Non-reactive
SALIENT
FEATURES
Preterm Labor with Intact 26 4/7 weeks AOG Cannot be totally ruled
Membrane Painful regular uterine contraction out
Cervical change (3 cm dilated, 80%
effaced)
History of UTI
(+) external manipulation
Intact BOW
Plan
WOF:
DTR <2+
UO <30cc/hr
RR <12 cpm
Plan
Singh,Priya
Threshold of Viability
newborns
Births once delivered before
considered to be Currently, the
33 weeks’
“abortuses” because threshold of viability
gestation,
the fetus weighed lies between 20 and
<500 g are now perinatal and
26 weeks’ gestation.
classified as live neonatal care has
births. advanced
tremendously.
Periviable Neonatal Survival
Pregnancy factor
genetic and environmental factor
Light and heavy bleeding
Birth defect
Lifestyle factor
Smoking , drugs and in adequate maternal weight gain
Poverty , short suture and vitamin deficiency
Genetic factor
❖ Periodontal disease –
associated with preterm birth
Treatment during pregnancy improved the disease but does not significantly
improve the preterm labour
SYMPTOMS:
Contractions
pelvic pressure, menstrual-like cramps, watery vaginal
discharge, and lower back pain
DIAGNOSIS
CERVICAL CHANGE:
Asymptomatic cervical dilation after midpregnancy
DIAGNOSIS
FETAL FIBRONECTIN:
fFN detection in cervicovaginal secretions before
membrane rupture
(+) values exceeding 50 ng/Ml
DIAGNOSIS
● Cervical Cerclage
● Prophylaxis with Progestogen Compounds
● Prior Preterm Birth and Progestogen Compounds
● Progesterone Use without Prior Preterm Birth
● Geographic-Based Public Health-Care Programs
● Spontaneous
delivery was
significantly
reduced
● FDA rejected
● Did not reduce
the frequency of
preterm birth
before 37 weeks
From all these studies, the American College of Obstetricians and Gynecologists concluded
that universal cervical length screening in women without prior preterm birth is not
mandatory. However, screening strategy could be considered in the context of treatment with
vaginal progesterone
Geographic-Based Public-Health Care Programs
- The diagnosis of suspected intraamniotic infection is made when the maternal temperature is
≥39.0°C OR when the maternal temperature is 38.0 to 38.9°C and one additional clinical risk factor
is present. (ACOG)
- Suggested factors include low parity, multiple digital examinations, use of internal uterine and
fetal monitors, meconium-stained amnionic fluid, and the presence of certain genital tract
pathogens
ANTIMICROBIAL THERAPY
● Intravenous ampicillin plus erythromycin every 6 hours for 48 hours, which was followed by
oral amoxicillin plus erythromycin, every 8 hours for 5 days.
○ The women had membrane rupture between 24 and 32 weeks’
○ Antimicrobial-treated women had significantly fewer newborns with RDS, necrotizing
enterocolitis, and composite adverse outcomes
● Three-day treatments compared with 7-day regimens using either ampicillin or ampicillin-
sulbactam appear equally effective in regard to perinatal outcomes
•Rescue therapy
- Administration of a second corticosteroid dose when delivery becomes
imminent and more than 7 days have elapsed since the initial dose
3. Magnesium Sulfate
•Prophylaxis for neuroprotection
•Reduces risk for cerebral palsy
MANAGEMENT OF PRETERM LABOR WITH INTACT MEMBRANE
4. Antimicrobials:
- Antimicrobial prophylaxis given to women with intact
membranes did not reduce preterm birth rates or affect
other clinically important short-term outcomes (Flenady,
2013).
MANAGEMENT OF PRETERM LABOR WITH INTACT MEMBRANE
5. Bed Rest
- Most often prescribed interventions
- Some studies have shown no benefits:
- Thromboembolic complications
- Significant bone loss
- Increased risk for preterm birth before 34 weeks
- Recommendation: Ambulation
MANAGEMENT OF PRETERM LABOR WITH INTACT MEMBRANE
6. Cervical Pessaries
- Silicone rings
- Used to support incompetent/short
cervix (≤25 mm)
- Conflicting results from several
studies on its use in preterm birth
prevention.
7. Emergency or Rescue
Cerclage
8. Tocolysis
•Uterine relaxants/ Labor suppressants
•Delay delivery for up to 48 hours
•For short-term use
•Maintenance tocolysis after acute therapy is not recommended.
•Benefits:
-Allow corticosteroids administration and elicit its action
-To permit the transfer of the mother to a center with a NICU
Labor
- Induced or spontaneous preterm labor necessitates
continuous monitoring of:
a.Fetal heart tone
b.Uterine contractions
- Ruptured membrane followed by fetal tachycardia
suggest sepsis.
- GBS infection common, antimicrobial prophylaxis should
be given.
- Intrapartum acidemia (pH <7.0) may intensify neonatal
complications attributed with preterm delivery.