9/19/2023 0 Comments Low amniotic fluid at 36 weeks![]() In a randomized placebo-controlled trial, treatment with vaginal micronized progesterone, 200 mcg daily, was associated with a 44% reduction in spontaneous preterm delivery in asymptomatic women with a cervical length of 15 mm or less at 20 to 25 weeks' gestation (RR = 0.56 95% CI, 0.36 to 0.86). 23, 26 Vaginal progesterone can be used in women with no history of spontaneous preterm delivery if they have a cervical length of 20 mm or less before 24 weeks' gestation. Food and Drug Administration has approved hydroxyprogesterone caproate (Makena), 250 mg intramuscularly, as weekly injections. Progesterone supplementation is beneficial in these women starting at 16 to 24 weeks' gestation and continuing through 34 weeks' gestation. In women with single gestation pregnancy and a history of spontaneous preterm delivery, antenatal progesterone therapy is the most effective strategy to decrease the risk of a recurrent preterm delivery. Vaginal bleeding caused by placental abruption or placenta previa Shortened cervix (< 25 mm before 28 weeks' gestation) Short pregnancy interval (< 18 months between pregnancies) Sexually transmitted infections (i.e., chlamydia, gonorrhea, and trichomoniasis) Medical disorders such as thyroid disease, diabetes mellitus, or hypertension Low prepregnancy body mass index (≤ 19.8 kg per m 2) Infections of the urinary and genital tracts History of cervical conization or a loop electrosurgical excision procedure of the cervical transformation zone Intervention to modify risk factor improves neonatal outcomes? Tocolytics, such as prostaglandin inhibitors and calcium channel blockers, should be used to prolong the time to delivery so that antenatal corticosteroids and potentially magnesium sulfate can be administered, and the mother can be transferred to a tertiary facility with a neonatal intensive care unit. It is recommended between 24 and 34 weeks' gestation and may be considered as early as 23 weeks' gestation.Īntenatal magnesium sulfate provides neuroprotection, decreasing the risk of cerebral palsy in infants born at less than 32 weeks' gestation. Once preterm labor is confirmed, a single course of corticosteroids (betamethasone or dexamethasone) is the only intervention for improving neonatal outcomes. In women with a single gestation pregnancy and a history of spontaneous preterm delivery, progesterone supplementation is beneficial starting at 16 to 24 weeks' gestation and continuing through 34 weeks' gestation. When used in specific at-risk populations, magnesium sulfate provides neuroprotection and decreases the incidence of cerebral palsy in preterm infants. Tocolytics, especially prostaglandin inhibitors and calcium channel blockers, may allow time for the administration of antenatal corticosteroids and transfer to a tertiary care facility if necessary. A course of corticosteroids is the only antenatal intervention that has been shown to improve postdelivery neonatal outcomes, including a reduction in neonatal mortality, intracranial hemorrhage, necrotizing enterocolitis, and neonatal infection. Cervical cerclage has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. Current recommendations are to prescribe vaginal progesterone in women with a shortened cervix and no history of preterm delivery, and to use progesterone supplementation regardless of cervical length in women with a history of spontaneous preterm delivery. Antenatal progesterone is associated with a significant decrease in subsequent preterm delivery in certain pregnant women. Women with a history of spontaneous preterm delivery are 1.5 to two times more likely to have a subsequent preterm delivery. Less than 10% of women with a clinical diagnosis of preterm labor will deliver within seven days of initial presentation. Clinical diagnosis of preterm labor is made if there are regular contractions and concomitant cervical change. The rate of preterm delivery (before 37 weeks' gestation) has been declining since 2007. ![]() In the United States, preterm delivery is the leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy. ![]()
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