Management of Labor
Management of Labor
Management of Labor
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<strong>Management</strong> <strong>of</strong> Signs/Symptoms <strong>of</strong> Preterm <strong>Labor</strong> (PTL) Algorithm<br />
This algorithm applies to singleton pregnancies only.<br />
2 0<br />
Assessment includes:<br />
• Sterile speculum exam<br />
- Fetal fibronectin testing<br />
- Consider GBS, wet prep<br />
for bacterial vaginosis<br />
- GC, chlamydia<br />
• Digital cervical exam<br />
• Transvaginal ultrasound<br />
for cervical length (if<br />
available)<br />
• Ultrasound for growth,<br />
fluid, placenta<br />
• Assess contraction patterns<br />
• Assess fetal well-being<br />
• Urinalysis and urine culture<br />
2 3<br />
Critical events:<br />
• Cervix 5+ cm dilated<br />
• pPROM<br />
• Vaginal bleeding<br />
• Chorioamnionitis<br />
suspected<br />
Institute for Clinical Systems Improvement<br />
2 0<br />
Assessment <strong>of</strong> patient with<br />
signs/symptoms <strong>of</strong> possible PTL<br />
2 1<br />
Patient and fetus<br />
both medically<br />
stable?<br />
2 3<br />
Is there a critical<br />
event?<br />
2 5<br />
Cervix > 2 cm<br />
dilated, > 80%<br />
effaced, contractions<br />
4/20 or 6/60?<br />
2 6<br />
yes<br />
no<br />
no<br />
Ultrasound cervical<br />
length < 2.5 cm or fFn<br />
positive?<br />
no<br />
2 8<br />
See ICSI Routine<br />
Prenatal Care<br />
guideline<br />
A<br />
no<br />
yes<br />
yes<br />
yes<br />
2 2<br />
Obstetric/medical<br />
consultation as indicated;<br />
treat per standard emergency<br />
medical and obstetric<br />
procedures<br />
2 4<br />
See <strong>Management</strong> <strong>of</strong> Critical<br />
Event algorithm<br />
2 7<br />
Monitor for minimum<br />
2 hours for cervical<br />
changes<br />
2 9<br />
Cervical change?<br />
no<br />
yes<br />
3 1<br />
• Consider antenatal cortiosteroids<br />
• Dismiss and schedule weekly<br />
follow-up<br />
- Digital exam to assess cervix<br />
- Repeat fFn until 33 weeks plus<br />
6 days<br />
<strong>Management</strong> <strong>of</strong> <strong>Labor</strong><br />
Third Edition/May 2009<br />
3 0<br />
See <strong>Management</strong> <strong>of</strong><br />
Critical Event algorithm<br />
www.icsi.org<br />
2
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