Preterm labor
Background
- Defined as labor before 37 weeks (uterine ctx and cervical change)
- Increased risks to child depending on age of fetus
- Cerebral palsy, poor lung development, cognitive delay, etc
- Can be triggered by maternal infx, stress, HTN, uncontrolled DM
Clinical Presentation
- Similar to term labor
- Uterine contractions q 10 min (may be irregular)
- New onset of vaginal mucus, blood, pink discharge, amniotic fluid
- Low back ache, vaginal pressure
Differential Diagnosis
Diagnosis
- Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant
- Start with ultrasound to assess position of cervix and r/o placenta previa
- Swabs for fetal fibernectin, Group B strep should also precede digital exam
- Proceed with digital exam if placental previa unlikely, and digital exam is urgently needed to assist patient care, such as in fetal HR decels
Management
- Fetal Heart Monitor
- U/S to assess placental position