Spec & Check
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PTL symptoms are often nonspecific and can include: pain/ctx/cramping, bleeding, pressure, increased discharge or leaking fluid, abnormal discharge, diarrhea, etc. Patients presenting with the symptoms should get the "Spec and Check" evaluation in triage.
Risks for PTL include: history of PTL, extremes of age, poor nutritional status, STDs, tobacco use, drug use and CL < 20 mm or CL 20-29 mm with pos fFN.
Spec & Check
Perform SSE
collect (1) fFN FIRST (consider UTD algorithm)
(Only if nothing in the vagina x 24 hours and no bleeding or other obvious causes of false pos)
most useful between 22 0/7 and 34 6/7 weeks of gestation
ROM+ (if indicated)
GC/CT
slides - fern/KOH/wet prep
GBS (if grossly ruptured)
If low suspicion for ROM, perform cervical exam
Review slides and send GC/CT (not fFN).
If cervix feels anything but cl/th/hi and you still have concerns for PTL (ie - ctx on TOCO) -> get CL
If CL less than 30mm, send fFN
Manage clinical findings as indicated
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