Preterm Labor and PPROM

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