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Preterm Labor Prevention Guide for High-Risk Patients
- 1. Preterm Labor Prevention and Treatment Kerry Watrin MD August 2 nd 2007
- 4. Race/Ethnicity and Prematurity 2000to 2002 1.5% 10.7% White 1.4% 10.2% Asian 1.7% 11.4% Hispanic 2.0% 12.9% Native American 4.1% 17.6% Black 1.9% 11.9% All US < 32wk US < 37wk Race/Ethnicity
- 11. Expected pregnancy weight gain 15+ lbs > 29 Obese 15-25 lbs 26-29 High 25-35 lbs 19.8-26 Normal 28-40 lbs <19.8 Low Recommended wt gain BMI Kg/m2 Wt/ht category
- 14. Bacterial Vaginosis: Clue cell
- 20. Preterm outcomes and Progesterone NNT Relative Risk Placebo N=153 Progest N=306 7 0.66 (.51-.87) 62 41.1% 82 27.2% LBW < 2500 gm 12 0.58 (.37-.91) 30 19.6% 35 11.4% Delivery < 32 wk 10 0.67 (.48-.93) 47 30.7% 63 20.6% Delivery < 35 wk 5 0.66 (.54-.81) 84 54.9% 111 36.3% Delivery < 37 wk
- 33. Rate of Preterm Birth <35 weeks by Cervical Length at 24 weeks 34 % < 13 mm 20 % <20 mm 8 % 25 mm Rate Delivery Length
- 34. Ultrasound Cervical Length Prediction of PTB < 35 weeks 17.2% 96.6% 94.5% 25.4% Funneling At 24 wk 17.8% 97% 92.2% 37.3% 25mm 24 weeks 16.7% 97.6% 94.7% 31.3% 20 mm 28 weeks 25.7% 96.7% 97% 23% 20mm 24 weeks PPV NPV Specificity Sensitivity Finding
- 42. Contractions what to do? 4 (7%) 4 (6%) 5 (9%) PTB < 34 wks $687 $966 $717 Mean cost < 24 hours 5 (8%) 8 (13%) 7 (13%) admitted 8 (13%) 8 (13%) 10 (18%) More tocolysis 79% 57% 64% Triage < 4hrs 4.1 5.1 hrs 6.0 5.7 hrs 5.2 5.1 hrs Mean time to discharge Terbutaline x1, n=61 Hydration N=62 Observation N=56
- 45. The Recommendations MMWR, Vol 51 (RR-11)
- 87. Risk of Preterm Birth < 35 weeks compared to cervical length of the 75% 1.0 1.0 75% 40 mm 9.5 6.7 10% 26 mm 13.9 9.5 5% 22 mm 24.9 14 1% 13 mm 28 weeks RR of PTB 24 weeks RR of PTB Percentile On Curve Length
- 90. Tocolytics: - mimetics 2004 Systematic Review OR 0.79 CI (0.61-1.01) 5 RTC 55%, 332/601 mimetic 65%, 332/525 placebo LBW < 2,500 gms OR 0.76 CI (0.57-1.01) 6 RTC 18%, 117/639 mimetic 25%, 140/565 placebo RDS OR 1.08 CI (0.72-1.62) 7 RTC 9%, 62/682 mimetic 8%, 48/604 placebo Perinatal Mortality OR Sample Finding
Notas del editor
- Workshop 9/14/2004 32 nd Annual Advances in Family Practice and Primary Care: Perinatal Case Studies