6.2.2 Premature/preterm labour- exam Flashcards
Explain the risk factors, potential causes and complications associated with preterm labour
Risk Factors
- intra-amniotic infection
- Placental abruption
- invasive uterine procedures
-maternal illness
- Pre-eclampsia
- covid
- incomponent cervix
- short cervical length
- cervical surgery - cone bx
- multiple termination
- multiple pregnancy twins etc
- infection
-UTI
-GBS
- smoking
- stress - extreme
- nil antenatal care
- trauma
-low socioecomontic
- vaginal bleeding
- IVF - not spontaneous pregnancy quality of sperm/egg
- uterus abnormality - bi-cone uterus
-APH
Explain the medical management of preterm labour
- phx
- if contractions commenced
- OBS
- CTG
- Timing
- amnisure
- spectum <37 week not within midwife scope of practice
- no VE’s
- HVS- GBS
- LVS - GBS
- UTI - MSU and dipstick
- (no digital exam)
- looking for cervical changes
- give a pad to place insitu
- any pooling fluid
- incontinence verves preterm rupture of membranes
- threatened labour is not preterm labour
- infection delivery is warranted
- tocolytic
- swab - fetal fibronectin - Fetal fibronectin is a protein that’s believed to help keep the amniotic sac “glued” to the lining of the uterus. The amniotic sac is the fluid-filled membrane that cushions your baby in the uterus. If this connection is disrupted, fetal fibronectin can be released into secretions near your cervix
- if positive transfer the woman out to a tertiary hospital.
- intact membranes - fetal fibronectin only
Incorp a woman centred approach, explain the midwifery care for the women experiencing preterm labour as part of the multi disciplinary team
- tocolytic
- c
Describe the leading cause of morbidity and mortality of preterm neonates
- Respiratory distress
- Infection
- Intraventricular hemorrhage
Describe the risk factors, signs and symptoms of preterm labour
Maternal Characteristics
- Short cervical length <25 mm
- Cervical surgery
- vaginal bleeding
- UTI
- Periodontal infections
- smoking
- substance abuse
- Alcohol consumption
- low maternal BMI
- short interpregnancy interval
Describe the indication and contraindication of medications used in preterm labour (note: nifefipine no long available)
- corticosteroids used <35 weeks to help mature fetal lungs & surfactant
- Tocolytic - which are smooth muscle relaxant to administer
- antibotics prophylatic
- preterm - sespis
- between 24-34 weeks gestation - corticosteroids to be administered
- matures fetal lungs
- decreased respiratory
-NEC - Short term Tocolytic therapy
- magnesium sulfate <32 - reduces cerbal palsy
Common tocolytics
Common Contraindication
Calcium channel blockers Hypo tension or pre load
Dependent cardiac
lesions eg: aortic
insufficiency
NSAIDS Platelet dysfunction or
bleeding disorder, hepatic
dysfunction, GI ulcerative
disease, renal dysfunction
and asthma
Beta-adrenergic receptor Agonist tachycardia-sensitive
maternal cardiac disease
poorly controlled DM
Magnesium Sulfate Myasthenia gravis
tyocolytic medications are only used for short term benefits and should not be used as a long term solution
Progesterone therapy
- inhibition of cervical ripening
- Reduction of myometrial contractility
- Modulation of inflammation
When is transfer recommended
- <32 weeks if regional
- transfer to tertiary centres
- call “PIPER”
What is the classification of preterm labour
- Preterm labour onset of spontaneous labour before 37 week gestation
20 - 37 weeks gestation- preterm labour =
Uterine Contractions + Cervical dilation and/or Effacement
- preterm labour =
Risk factors associated with preterm labour and birth - Maternal Characteristics
- > 18 years of age
- < 35 years of age
- Ethnicity
- Aboriginal - risk increased by 70%
- African - Risk increased by 60%
- South Asian - Risk increased by 40%
- Smoking
- High level of psychological stress
- Later booking or no pregnancy care
- Low socio-economic status
- BMI <19
- BMI >30
Risk factors associated with preterm labour and birth - Medical and pregnancy conditions
- Previous preterm birth
- Short cervical length
- PPROM
- Multiple gestation
- Presence of fetal fibronectin in vaginal secretions
- Genital tract infections
- UTI
- Vaginal Bleeding
- Conceived using artificial reproductive technology (ART)
- Cervical surgical procedures
- Uterine anomalies
- Polyhydramnios
- Oligohyramnios
- Chronic medical conditions
- Acute medical conditions (Pre-eclampsia & APH)
Assessment of PPROM via phone
Via phone
- timing of membrane rupture
- volume, colour and odour
- suggest placing a pad insitu
- are you feeling unwell - fever/chills/rigors
- Is the baby moving normally
- obstetric past hx:
- this pregnancy
- C Section
- type of pregnancy singeton or multi
- G & P
Assessment of PPROM on presentation
On presentation
- general & obstetric examination
- abdo palpation
- confirm colour of liquor
- sterile speculum may be indicated (not a midwifery skill)
- Amnisure
- HVS
- LVS
Fetal monitoring
- > 26 weeks CTG may be indication if concerns about fetal wellbeing after GH is auscultated
- IVABS should commence
- U/S for AFI
Management of PPROM
< 34 weeks gestation - IOL should not be preformed unless there is additional clinical indications
->34 weeks gestation - risk verves benefits of IOL
- SCN
- Transfer out
- if birth at <34 weeks or suspected chorioamnionitis ensure placenta is sent for histo
