A 32 year old female with a history of 2 mid-trimester abortions, comes now with 32 weeks of pregnancy and labour pains with Os dilated 2 cm. All are done, except:
Correct Answer: Antibiotics
Description: In the question, patient is presenting with history of 2 midtrimester abortions and gestational age is 32 weeks with labor pains and dilatation of cervix 2 cm
The membranes are not ruptured, hence management includes:
Betamethasone: To accelerate lung maturation of the fetus.
Tocolysis: Tocolytics are not given with the aim to arrest preterm labor for a long time, but to prolong the labor for 48 hours.
This servers the following purposes:
The corticosteroids get time to act.
Allows time for transport of the woman to better obstetrical centre.
Beta-adrenergic agonists, calcium-channel blockers, or indomethacin are the recommended tocolytic agents for such short-term use–up to 48 hours. American college of obstetrics and gynecology recommends that women with preterm contractions without cervical change, especially those with cervical dilation of less than 2 cm, generally should not be treated with tocolytics.
In general, if tocolytics are given, they should be administered concomitantly with corticosteroids. The gestational age range for their use in debatable. However, because corticosteroids are not generally used after 33 weeks and because the perinatal outcomes in preterm neonates are generally good after this time, most practitioners do not recommend use of tocolytics at or after 33 weeks. In this patient G: Age is 32 weeks and cervix is 2 cm dilated so the use of tocolytics is justified
Rescue cerclage (Williams 24/e, p 857): There is support for the concept that cervical incompetence and preterm labor lie on a spectrum leading to preterm delivery. If cervical incompetence is recognized with threatened preterm labor, then emergency cerclage can be attempted.
Cervical cerclage is done in 3 conditions:
Cervical incompetence
Prophylactically in women identified on USG to have short cervix <15 mm
Rescue cerclage–as discussed above.
Antibiotics: Do not have a role in preterm pregnancy with intact membranes. In a study (ORACLE 11 trial) antimicrobials were given to patients with preterm labor but without membrane rupture, the results were disappointing. In his review, Goldenberg (2002) also concluded that antimicrobial treatment of women with preterm labor for the sole purpose of preventing delivery is generally not recommended. In a follow-up of the ORACLE II trial, Kenyon and associates (2008 b) reported that fetal exposure to antimicrobials in this clinical setting was associated with an increased cerebral palsy rate at age 7 years compared with that of children without fetal exposure.
Category:
Gynaecology & Obstetrics
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