Show Notes
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
