EXPLANATION FOR QUESTION 19

 QUESTION 19

Preterm birth (delivery at <37 weeks gestation) is a leading cause of neonatal morbidity and mortality Patients at risk for
spontaneous preterm delivery must be identified to implement appropriate measures for preterm birth prevention The major risk
factor for preterm delivery is a history of preterm delivery due to spontaneous preterm labor or preterm premature rupture of
membranes, which confers approximately 20% risk for future spontaneous preterm birth.
For patients with this history, intramuscular progesterone during the second and third trimesters can minimize the risk of recurrence.
In addition, serial cervical length measurements by transvaginal ultrasound should be performed during the second trimester. A
cerclage should be considered if a short cervix is identified.
Prior cervical surgery, particularly cold knife conization, is a risk factor for preterm delivery, possibly due to cervical scarring and loss
of cervical stroma. A loop electrosurgical excision procedure (LEEP) may or may not confer a risk of preterm delivery, but cervical
laser ablation (Choice E) does not increase that risk. Other risk factors for preterm delivery include obesity (Choice A), in vitro
fertilization (Choice 0), and advanced maternal age (Choice F). Tobacco use (Choice G) is a modifiable risk factor for preterm
delivery. However, all of these factors are less significant than a history of prior spontaneous preterm delivery.
(Choice B) Gastric bypass and other bariatric surgeries increase the risk of anemia in pregnancy and for cesarean delivery but not
for spontaneous preterm delivery.
Educational objective:
The most significant risk factor for spontaneous preterm delivery is a history of spontaneous preterm delivery in a prior pregnancy
Patients with this history can be managed with progesterone supplementation and serial cervical length measurements.