Question

Discuss the diagnosis and management of a G1P0 with 30 weeks pregnancy presenting with suspected preterm labor. [2+4]

Hint:

Antenatal corticosteroids and tocolytics are key components of managing suspected preterm labor. Timely intervention can significantly improve neonatal outcomes.

Answer 1

Step 1: Diagnosis of Suspected Preterm Labor in a G1P0 with 30 Weeks Pregnancy.
The diagnosis of preterm labor is clinical and is based on the presence of regular uterine contractions and cervical changes before 37 weeks. Key diagnostic steps include:
(1) History and Symptoms: - The woman may present with regular uterine contractions occurring every 5 minutes or less, lower abdominal cramping, and lower back pain. Symptoms may be intermittent or persistent.
- Vaginal discharge: Check for any bloody show or amniotic fluid leakage, which may suggest rupture of membranes or the need for further assessment.
(2) Physical Examination: - Cervical examination to assess cervical dilatation and effacement. Any cervical changes (especially >1 cm dilation or >50% effacement) suggest the onset of preterm labor.
- Fetal Heart Rate Monitoring: To assess fetal well-being, typically using a non-stress test (NST) or electronic fetal monitoring.
(3) Ultrasound: - Perform a transabdominal ultrasound to confirm fetal viability, assess amniotic fluid volume, and check fetal position.
- Measure cervical length via transvaginal ultrasound. A cervical length <25 mm is associated with a higher risk of preterm labor.
(4) Laboratory Tests: - Fetal fibronectin test (fFN): A negative result can rule out preterm labor, while a positive result indicates an increased risk but is not diagnostic.
- C-reactive protein (CRP): Elevated levels may suggest infection, which could contribute to preterm labor.
Step 2: Management of a G1P0 at 30 Weeks Pregnancy with Suspected Preterm Labor.
The management of a woman at 30 weeks with suspected preterm labor involves several key components, including stabilization, tocolysis, steroid administration, and monitoring. The following steps should be taken:
(1) Hospitalization and Monitoring: - The patient should be hospitalized for monitoring of fetal heart rate, maternal vitals, and contraction frequency. Continuous monitoring can help assess the progression of labor.
- A non-stress test (NST) or biophysical profile (BPP) can be performed to evaluate fetal well-being.
(2) Tocolysis: - If preterm labor is diagnosed, tocolytics may be used to suppress contractions and delay delivery. Medications such as magnesium sulfate, nifedipine, or terbutaline may be used, depending on the clinical situation.
(3) Antenatal Corticosteroids: - Betamethasone (12 mg IM every 24 hours for two doses) should be given to promote fetal lung maturity and reduce the risk of respiratory distress syndrome in preterm infants. This is most effective when administered between 24-34 weeks of gestation.
(4) Antibiotics (if neede: - Group B Streptococcus (GBS) prophylaxis with penicillin or ampicillin may be administered if there is any risk of infection, especially if membranes have ruptured or if there is concern for chorioamnionitis.
(5) Monitoring and Decision on Delivery: - Cervical length measurement may guide the decision on delivery. If the cervix is less than 25 mm and contractions persist, delivery may be considered.
- If labor progresses or fetal compromise occurs, early delivery may be necessary. Consider cesarean section if there are any signs of fetal distress or if the cervix fails to dilate appropriately.