R/O PTL

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# Rule out preterm labor
***Based on history and exam, low suspicion for preterm labor.
- Toco without regular contractions.
- No evidence of ROM.
- No evidence of cervical change.
- Patient without*** history of PTL.
- Plan to discharge home with preterm labor precautions discussing when to return to the hospital, including contractions 3-4 minutes apart for at least 1 hour; heavy vaginal bleeding; and/or rupture of membranes. She voiced understanding of these instructions and was discharged home in stable condition.  Pt has a follow-up as listed below.

***# Contractions, preterm; unclear if preterm labor
- Will replete PO***IV fluids to assess for uterine irritability
- Recheck cervix in two hours
- Keep on continuous monitoring in interim

***# Preterm labor, evidenced by presence of regular contractions and cervical change +/- ROM***
- Fetal neuroprotection: 6mg Magnesium Sulfate bolus infusion, followed by 2mg/hr infusion given GA <32 weeks and likelihood of delivery within the next 24h
- Antenatal corticosteroids: 12mg Betamethasone daily x 2 doses q24h
- GBS: negative or positive/unknown***2g Ampicillin IV bolus, followed 1g IV q4h until delivery
- 50mg Indocin PO loading dose, followed by 25mg q6h for tocolysis during steroid administration
- 30mg Procardia loading dose, followed by 10mg q6h for tocolysis during steroid administration
- 1L LR bolus for uterine irritability
- Peds/NICU consult
- Evaluation for infection:

The following were reviewed/collected in triage:
[X] GC/CT - collected***
[X] Wet prep - ***
[X] UA - wnl***
[X] Urine culture - collected***

Yellow *** markers = placeholders you fill in or delete per case.