December 13, 2017

Preterm Labor and PPROM

20 minutes

Preterm labor and preterm premature rupture of membranes (PPROM) are critical diagnoses on L&D. This episode reviews the evaluation approach – from sterile speculum exam to fetal fibronectin – and the management protocols including magnesium for neuroprotection, betamethasone, tocolysis, and latency antibiotics. Based on ACOG Practice Bulletin #171.

Show Outline:

PTL/TPTL – Preterm (<37wks) with cervical change

Evaluation – SSE first: collect GC/CT cultures, FFN (no gel, blood, or semen), GBS, evaluate for rupture if needed. SVE for dilation/effacement changes.

If tPTL

Magnesium for neuroprotection (<32wks to decrease CP rates)

Betamethasone for fetal lung development

PCN

Tocolysis for the steroid window (48hrs) if <34wks (indomethacin if <32wks, nifedipine if 32+wks)

IV fluids

NICU consult

PPROM – Preterm (<37wks) with ruptured membranes. Confirm with pooling, nitrazine, ferning.

If PPROM – Delivery at 34wks or at diagnosis if chorio/34+wks

Latency antibiotics (Erythromycin/Azithromycin + Ampicillin × 2 days, then PO Erythro/Amoxicillin × 5 days)

Magnesium, betamethasone, PCN

NO tocolysis

NICU consult

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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By Jennifer Doorey, MD, MS

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December 13, 2017

Preterm Labor and PPROM

20 minutes

Show Outline:

PTL/TPTL – Preterm (<37wks) with cervical change

Evaluation – SSE first: collect GC/CT cultures, FFN (no gel, blood, or semen), GBS, evaluate for rupture if needed. SVE for dilation/effacement changes.

If tPTL

Magnesium for neuroprotection (<32wks to decrease CP rates)

Betamethasone for fetal lung development

PCN

Tocolysis for the steroid window (48hrs) if <34wks (indomethacin if <32wks, nifedipine if 32+wks)

IV fluids

NICU consult

PPROM – Preterm (<37wks) with ruptured membranes. Confirm with pooling, nitrazine, ferning.

If PPROM – Delivery at 34wks or at diagnosis if chorio/34+wks

Latency antibiotics (Erythromycin/Azithromycin + Ampicillin × 2 days, then PO Erythro/Amoxicillin × 5 days)

Magnesium, betamethasone, PCN

NO tocolysis