ACOG Practice bulletin: # 171

PTL or TPTL:  Preterm <37wks, cervical change

Evaluation:

SSE first: Collect GC/CT cultures, FFN (no gel, blood or semen), GBS, eval for rupture if needed

SVE:

Cervical change–can dilation or effacement changes

FFN: Fetal fibronectin

If tPTL:

• Magnesium for neuroprotection if <32wks, decrease CP rates


• Betamethasone for fetal lung development


• PCN


• Tocolysis for steroid window (48hrs) if <34wks, questionable if 34-36+6. Indocin if <32 wks, Nifidipine if 32+wks


• IV fluids


• NICU consult

PPROM: Preterm <37wks, Ruptured membranes

SSE: Confirm rupture with Pooling, nitrazine ferning. Collect GC/CT and GBS.

If PPROM: Delivery at 34wks or at diagnosis if chorio or 34+wks

• Latency antibiotics: Erythromycin/Azithromycin, Ampicillin x 2 days, PO Erythro/Amoxicillin x 5 days


• Magnesium for neuroprotection if <32wks, decrease CP rates


• Betamethasone for fetal lung development


• PCN


• NO Tocolysis


• NICU consult