(精选)Preterm Labor教学课件.pptVIP

Case 4 She progresses to fully dilated in the next 6 hours What should your considerations be when delivering her baby? Delivery management Important considerations for preterm delivery Contact NICU No vacuums 34 weeks Control head extension Delayed cord clamping Less need for transfusion Less hypotension Less anemia Less intraventricular hemorrhage No difference in death Timing of Umbilical Cord Clamping. ACOG Practice Bulletin 543, December 2012. Case 1 New OB visit for a 25yo G0101 at 16+0 with prior spontaneous preterm birth at 28 weeks What should she be offered and when? Case 1 IM progesterone to start at 16 weeks until 36 weeks Cervical length screening starting at 18-20 weeks q 2 weeks until 24 weeks You are paged when she is 20 weeks from New Mexico Sono- cervical length is 1.8cm! What do you do? Case 1 Cerclage Usually arranged through MFM clinic Case 1 She decides to go on vacation. You are working remotely in Shiprock when she presents at 36+1 with regular contractions and SROM What do you do? Remove the cerclage! Speculum exam, find knot Cut! Case 2 30 yo G1P0 currently at 20 weeks, found to have cervical length of 12mm on routine screening What should she be offered and when? Case 2 Vaginal progesterone Rx Eval for signs/symptoms of preterm labor Consider steroids Recheck cervical length in 7 days Is she a candidate for cerclage? Current ACOG consensus is no Diagnosis Only 30-60% of women presenting with preterm labor will lead to a preterm birth 4 main areas of concern that make a difference in survival of infant Transfer to hospital with NICU capabilities GBS prophylaxis Administration of steroids Magnesium for neuroprotection Sayres W. Preterm Labor American Family Physician 2010;81:477-484. ACOG Practice Bulletin 127, June 2012. Management of Preterm Labor Diagnosis Page from OBT: “30 weeker contracting” Assess patient as soon as you can Involve attending early Determine dates Earliest US most accurate What are her risk factors