Procedure Ready: Ob/Gyn

Preterm Labor and PPROM


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ACOG Practice bulletin: # 171

PTL or TPTL:  Preterm <37wks, cervical change

Evaluation:

SSE first: Collect GC/CT cultures, FFN (no gel, blood or semen), GBS, eval for rupture if needed

SVE:

Cervical change–can dilation or effacement changes

FFN: Fetal fibronectin

If tPTL:

  • Magnesium for neuroprotection if <32wks, decrease CP rates
  • Betamethasone for fetal lung development
  • PCN
  • Tocolysis for steroid window (48hrs) if <34wks, questionable if 34-36+6. Indocin if <32 wks, Nifidipine if 32+wks
  • IV fluids
  • NICU consult
  • PPROM: Preterm <37wks, Ruptured membranes

    SSE: Confirm rupture with Pooling, nitrazine ferning. Collect GC/CT and GBS.

    If PPROM: Delivery at 34wks or at diagnosis if chorio or 34+wks

    • Latency antibiotics: Erythromycin/Azithromycin, Ampicillin x 2 days, PO Erythro/Amoxicillin x 5 days
    • Magnesium for neuroprotection if <32wks, decrease CP rates
    • Betamethasone for fetal lung development
    • PCN
    • NO Tocolysis
    • NICU consult
    • ...more
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      Procedure Ready: Ob/GynBy Jennifer Doorey, MD, MS

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