Preterm labor - Revision history

Danbot: Add betamethasone MedicationDose entry for fetal lung maturity

2026-03-20T19:01:22Z

Add betamethasone MedicationDose entry for fetal lung maturity

← Older revision		Revision as of 19:01, 20 March 2026
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	\| route = SC		\| route = SC
	\| context = Tocolytic		\| context = Tocolytic
			\| indication = Preterm labor
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Betamethasone
			\| dose = 12mg IM q24hr x 2 doses
			\| route = IM
			\| context = Fetal lung maturity (24-34 weeks gestation)
	\| indication = Preterm labor		\| indication = Preterm labor
	\| population = Adult		\| population = Adult

Danbot: Add MedicationDose entries (magnesium sulfate, indomethacin, nifedipine, terbutaline) with SMW annotations

2026-03-20T18:56:41Z

Add MedicationDose entries (magnesium sulfate, indomethacin, nifedipine, terbutaline) with SMW annotations

@@ Line 71: / Line 71: @@
 *[[Nifedipine]] 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx
 *[[Terbutaline]] 0.25mg sq q20-30 min up to 4 doses PRN ctx
 ==Disposition==

Cmb23: /* Management by Weeks */

2023-10-29T00:47:00Z

Management by Weeks

← Older revision		Revision as of 00:47, 29 October 2023
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	**[[Antibiotics]] for GBS prophylaxis if status unknown		**[[Antibiotics]] for GBS prophylaxis if status unknown
	**Other antibiotics only indicated in setting of active infection		**Other antibiotics only indicated in setting of active infection
			*34-36 weeks
			**A single course of betamethasone is recommended to those who have not received a previous course <ref> https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation#:~:text=A%20single%20course%20of%20betamethasone,previous%20course%20of%20antenatal%20corticosteroids. </ref>

	===Tocolysis===		===Tocolysis===

Rossdonaldson1: /* Background */

2021-11-25T12:19:04Z

Background

← Older revision		Revision as of 12:19, 25 November 2021
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	==Background==		==Background==
			[[File:Bumm 123 lg - Copy.jpg\|thumb\|Estimated gestational age based on physical exam.]]
	*Defined as labor before 37 weeks (uterine contraction and cervical change)		*Defined as labor before 37 weeks (uterine contraction and cervical change)
	*Increased risks to child depending on age of fetus		*Increased risks to child depending on age of fetus

Lyssa1219: /* Management */

2020-04-15T19:04:56Z

Management

← Older revision		Revision as of 19:04, 15 April 2020
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	==Management==		==Management==
	*IV access, ABCs		*IV access x2, ABCs
	*Fetal heart monitor		*Fetal heart monitor
	*Immediate obstetrical consult		*Immediate obstetrical consult

Lyssa1219: /* Evaluation */

2020-04-15T19:04:30Z

Evaluation

← Older revision		Revision as of 19:04, 15 April 2020
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	==Evaluation==		==Evaluation==
	*Type and Screen, CBC, Chem 10, Coags, U/A with culture, Utox (cocaine increases risk of abruption)		*Type and Screen, CBC, Chem 10, Coags, U/A with culture, Utox (cocaine increases risk of abruption)
	*Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant		*Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant due to potential for placenta previa
	*Start with ultrasound to assess position of cervix and rule out placenta previa		*Start with ultrasound to assess position of cervix and rule out placenta previa
	*Swabs for nitrazine, fetal fibronectin (FFN), GBS culture should also precede digital exam		*Swabs for nitrazine, fetal fibronectin (FFN), GBS culture should also precede digital exam

ClaireLewis at 14:28, 5 September 2019

2019-09-05T14:28:33Z

← Older revision		Revision as of 14:28, 5 September 2019
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	*Similar to term labor		*Similar to term labor
	*Uterine contractions q 10 min (may be irregular)		*Uterine contractions q 10 min (may be irregular)
	*New onset of vaginal mucus, blood, pink discharge, amniotic fluid		*New onset of vaginal mucus, [[vaginal bleeding\|blood]], pink discharge, amniotic fluid
	*Low back ache, vaginal pressure		*Low [[back pain\|back ache]], vaginal pressure

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Management==		==Management==
	*IV access, ABCs		*IV access, ABCs
	*Fetal ~~Heart Monitor~~		*Fetal heart monitor
	*Immediate obstetrical consult		*Immediate obstetrical consult

Line 32:		Line 32:
	**Observation of 6 hours might be appropriate		**Observation of 6 hours might be appropriate
	*20-30mm - Increased risk for preterm labor		*20-30mm - Increased risk for preterm labor
	**Fetal ~~fibernetin~~ result can assist, if over 50ng/ml manage labor actively		**Fetal fibronectin result can assist, if over 50ng/ml manage labor actively
	*<20mm - labor very likely		*<20mm - labor very likely
	**Manage actively		**Manage actively
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	===Management by Weeks===		===Management by Weeks===
	*24-32 weeks		*24-32 weeks
	**~~Mag~~ sulfate (neuroprotection against cerebral palsy)		**[[Magnesium sulfate]] (neuroprotection against cerebral palsy)
	*<34 weeks		*<34 weeks
	**Hospitalization		**Hospitalization
	**Betamethasone 12mg IM q24hrs x2 doses		**[[Betamethasone]] 12mg IM q24hrs x2 doses
	**Tocolytics (see below for options/dosages)		**Tocolytics (see below for options/dosages)
	**Antibiotics for GBS prophylaxis if status unknown		**[[Antibiotics]] for GBS prophylaxis if status unknown
	**Other antibiotics only indicated in setting of active infection		**Other antibiotics only indicated in setting of active infection

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	====Contraindications====		====Contraindications====
	*~~Intratuterine~~ fetal demise / lethal anomaly		*Intrauterine fetal demise / lethal anomaly
	*Maternal hemorrhage or instability		*Maternal [[vaginal bleeding in pregnancy (greater than 20wks)\|hemorrhage]] or instability
	*Intraamniotic infection		*[[chorioamnionitis\|Intraamniotic infection]]
	*Severe preeclampsia or eclampsia		*Severe [[preeclampsia]] or [[eclampsia]]
	*Nonreassuring fetal status		*Nonreassuring fetal status
	*Contraindications to the drugs		*Contraindications to the drugs

Rossdonaldson1: Text replacement - " wks " to " weeks "

2019-03-30T16:02:07Z

Text replacement - " wks " to " weeks "

← Older revision		Revision as of 16:02, 30 March 2019
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	====Medications====		====Medications====
	*[[Indomethacin]] 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs. (avoid in gestation >32 ~~wks~~ for concern of premature narrowing or closure of the ductus arteriosus)		*[[Indomethacin]] 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs. (avoid in gestation >32 weeks for concern of premature narrowing or closure of the ductus arteriosus)
	*[[Nifedipine]] 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx		*[[Nifedipine]] 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx
	*[[Terbutaline]] 0.25mg sq q20-30 min up to 4 doses PRN ctx		*[[Terbutaline]] 0.25mg sq q20-30 min up to 4 doses PRN ctx

Rossdonaldson1: /* Management */

2018-06-07T18:13:27Z

Management

← Older revision		Revision as of 18:13, 7 June 2018
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	*IV access, ABCs		*IV access, ABCs
	*Fetal Heart Monitor		*Fetal Heart Monitor
			*Immediate obstetrical consult

	===Cervical length===		===Cervical length===
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	===Tocolysis===		===Tocolysis===
	*Indications		====Indications====
	**Only if fetus would benefit from delay in delivery of 48 hrs		*Only if fetus would benefit from delay in delivery of 48 hrs
	**Gestational age 22wks - 34 wks		*Gestational age 22wks - 34 wks
	**Transport to facility for definitive delivery		*Transport to facility for definitive delivery
	**Delay in delivery for treatment of reversible condition possibly triggering labor (UTI/pyelo)		*Delay in delivery for treatment of reversible condition possibly triggering labor (UTI/pyelo)
	***Betamethasone requires approximately 48 hrs for maximal benefit for lung maturity, reducing intraventricular hemorrhage, NEC, and death		**Betamethasone requires approximately 48 hrs for maximal benefit for lung maturity, reducing intraventricular hemorrhage, NEC, and death
	***Tocolysis rarely effective for longer than 48 hrs		**Tocolysis rarely effective for longer than 48 hrs
	***Does not remove underlying cause for tocolysis		**Does not remove underlying cause for tocolysis

	*Contraindications		====Contraindications====
	**Intratuterine fetal demise / lethal anomaly		*Intratuterine fetal demise / lethal anomaly
	**Maternal hemorrhage or instability		*Maternal hemorrhage or instability
	**Intraamniotic infection		*Intraamniotic infection
	**Severe preeclampsia or eclampsia		*Severe preeclampsia or eclampsia
	**Nonreassuring fetal status		*Nonreassuring fetal status
	**Contraindications to the drugs		*Contraindications to the drugs

	*Medications		====Medications====
	**[[Indomethacin]] 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs. (avoid in gestation >32 wks for concern of premature narrowing or closure of the ductus arteriosus)		*[[Indomethacin]] 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs. (avoid in gestation >32 wks for concern of premature narrowing or closure of the ductus arteriosus)
	**[[Nifedipine]] 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx		*[[Nifedipine]] 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx
	**[[Terbutaline]] 0.25mg sq q20-30 min up to 4 doses PRN ctx		*[[Terbutaline]] 0.25mg sq q20-30 min up to 4 doses PRN ctx

	==Disposition==		==Disposition==

Rossdonaldson1: /* Evaluation */

2018-06-07T18:11:28Z

Evaluation

← Older revision		Revision as of 18:11, 7 June 2018
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	==Evaluation==		==Evaluation==
			*Type and Screen, CBC, Chem 10, Coags, U/A with culture, Utox (cocaine increases risk of abruption)
	*Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant		*Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant
	*Start with ultrasound to assess position of cervix and rule out placenta previa		*Start with ultrasound to assess position of cervix and rule out placenta previa