PRETERM LABOR Threatened Ab

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PRETERM LABOR/ Threatened Ab

• Anna Mae Smith, MPAS, PA-C
• Lock Haven University of Pennsylvania
• Physician Assistant Program

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Early Abortion

• First trimester most often caused by
  chromosomal abnormality

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ETIOLOGY of Bleeding During Pregnancy

• Spontaneous abortion
• Ectopic Pregnancy
• Implantation bleeding
• Placental separation
• Subchorionic bleeding
• Friable cervix
• Sexual intercourse

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Ectopic Pregnancies

• Risk Factors
• sex at an early age (multiple partners)
• IUDs
• Abdominal Surgery (BTLs prev ectopic)
• Advanced maternal age
• Anatomic defects (uterine fibroids)
• Endocrine
• Immunology

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Terminology

• Threatened Ab- cramping bleeding without
  passage of tissue os is closed
  
• Inevitable Ab- threatened Ab with more severe
  cramping opened Os
  
• Incomplete Ab- bleeding passage of tissue but
  some is retained
  
• Complete Ab- Abortion is complete, tissue has
  passed, Os now closed
  

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6 week non-ruptured tubal pregnancy
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HP

• LMP
• Allergies
• Social history
• etc.

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Physical Exam

• Orthostatics
• Abdominal
• Pelvic

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Labs

• CBC
• Quantitative hCG
• Type crossmatch
• Ultrasound

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TREATMENT

• Wait See if stable Os closed
• Hemorrhaging - DC
• Rh negative moms need Rhogam!! (2-3 risk of
  these moms becoming isoimmunized)

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TREATMENT

• Threatened AB Positive heartbeat by
  ultrasoundwatched carefully, risk high of
  aborting. ?treat with progesterone /or HCG
  
• Complete AB Let nature take over
• Incomplete or Missed AB - D C

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TREATMENT

• Ectopic Surgery ASAP! Life threatening
• Methotrexate if hCG
  
• Hydatiform Mole Prompt DC close f/u
  thereafter(esp 1st year) for choriocarcinoma!

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PRETERM LABOR
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Epidemiology

• 7-10 of all pregnancies in the US
• Complications of prematurity are responsible for
  60 of perinatal morbidity mortality

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Demographic/Psychosocial Factors

• Low socioeconomic Status poor nutrition, poor
  prenatal care, psychosocial stress, smokers
  other drugs, poor work conditions, less
  education, single marital status
• Maternal Age - ,18 or 35
• Psychosocial Stress
• Maternal Work
• Maternal Habits cigs, cocaine, etoh
• Nutrition

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Physical Condition

• Maternal Infection
• Uterine enlargement multiple gestations,
  fibroids, polyhydramnios
  
• Cervical Status
• Frequent Uterine Contractions 4-6
  contractions/hr
  
• 2nd 3rd trimester vag bldg
• Uterine anomalies

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Diagnosis

• Regular uterine contractions every ten minutes or
  less lasting at least 30secs
  
• Progressive cervical effacement dilation over a
  30-60 minute time period or
  
• Cervix is effaced dilated 2 cms

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Inhibition of Labor/Tocolysis

• Healthy fetus
• Gestation between 20-34 weeks
• Cervical dilation 3-4cms or less
• Intact membranes

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Contraindications to Tocolytics

• Uncorrected fetal distress
• Obstetric complications
• abruptio placentae
• placentae previa with hemorrhage
• pre-eclampsia/eclampsia
• hemolytic disease
• hydramnios

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Contraindications to Tocolytics

• Chorioamnionitis
• Bulging membranes
• A disease that specifically contraindicates their
  use

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Treatment

• 50 of patients will respond to bedrest, mild
  sedation, avoidance of pelvic exams!
  
• Hydration with Lactated ringers

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Tocolytics

• Beta adrenergics (Terbutaline) - B2 relax uterus
  vessels
  
• Ritodrine -
• Magnesium sulfate smooth muscle relaxation
• Indomethacin Ca channel blockers??
• Treatment failure if cervix reaches 5cms