Case 8 - Preterm birth Flashcards
History
Examination
Investigations
History - normal obs history
- painful tightenings
- backache
- change in discharge
- show
- PPROM
Examination
- obs exam - fetal presentation, fetal lie, fetal length
- vaginal exam - cervical shortening, dilation
- Look for PPROM
Investigations
- FBC (anaemia)
- c reactive protein (preg inflammatory process)
- blood group and hold
- urinalysis
- vaginal swabs
- fetal fibronectin
- CTG
- US - fetal weight, presentation, liquor volume, cervical length
Differential diagnosis
Treatment plan
-Steroids
-
- What is preterm birth and how common is it?
Birth before 37 weeks
8% of births
- What are the relative contributions of iatrogenic and spontaneous preterm birth?
Iatrogenic - 1/3rd
Spontanous preterm birth -2/3rds
- Which factors increase the risk of spontaneous preterm birth?
Prior to pregnancy
Obs-Previous preterm birth, prev second trimester loss, prev abortion surgery
Gyne -Cervical incompetence (anaomaly), pervious cervical surgery
Pregnancy
Mum -Age <20, >40, Smoking, alcohol, BMI, Multiple preg
pressure
-polyhydraminos, bleeding in pregnancy
Inflammatory process
-bacterial vaginosis, UTI
- Which factors increase the risk of spontaneous preterm birth?
Prior to pregnancy
Obs-Previous preterm birth, prev second trimester loss, prev abortion surgery
Gyne -Cervical incompetence (anaomaly), pervious cervical surgery
Pregnancy
Mum -Age <20, >40, Smoking, alcohol, BMI, Multiple preg
pressure
-polyhydraminos, bleeding in pregnancy
Inflammatory process
-bacterial vaginosis, UTI
- What are the common causes of preterm labour?
Inflammatory stimulus
-infection, bleeding, uterine distension
- PPROM
- Infection
- Chromosomal abnormality
- Polyhydraminos
- What strategies could be used to prevent preterm labour?
- progesterone
- cervical staple
- antibiotics
- tocolysis - nifedepine
- What is the role of administering antenatal steroids to women at risk of preterm birth?
- improve development of babys lungs
- Prevent respiratory distress syndrome (most serious complication of prematurity)
- What are important features of the history and examination in a woman with suspected preterm
labour?
Symptoms - painful tightenings, backache, change in discharge, show, PPROM
Signs
-early engagement of presenting part, palpable tighetings, cervical shortening, cervical dilation, PPROM
- How would your management of a woman in preterm labour differ in a rural vs a tertiary hospital
setting?
Rural - give tocolysis to try and get mother to nearest place with NICU unit
Tertiary - can get to NICU
What is the fetal fibronectin test and what is its role in assessing a woman in suspected preterm
labour?
- Is an extraceullular matrix protein found in the decidua basalis, acts as a clue attatchign fetal membranes to decidua, If there is mechanical or inflammatory damage to placenta or membranes then this can be released . if elevated between 22-37 weeks, then abnormal.
- Has a good negative test but can get false positives.
- has to be done before a digital exam, b in absence of PPROM, and cervical dilation less than 3 cm and more than 48hrs sicne last sexual intercourse
- What is tocolysis? What drug is commonly used for tocolysis in New Zealand?
Medications to supress premature labour.
can be used in absence of infection, main benefit is to allow time for corticosteroids and time to arrange utero transfer to a hosptial with a neonatal unit. THe drug of choice is nifedipine.
- What investigations might be useful when assessing a woman in suspected preterm labour?
Investigations
- FBC (anaemia)
- c reactive protein (preg inflammatory process)
- blood group and hold
- urinalysis
- vaginal swabs
- fetal fibronectin
- CTG
- US - fetal weight, presentation, liquor volume, cervical length
- What are the general principles of management for women in preterm labour?
History, exam, investigations
admit to hospital - CTG, US
-try and manage until 37 weeks, and then induce then.
-If PROM - if infection - induce
- tocolysis
- Give corticosteroids and magenesium sulphate
- be near nicu unit
- screen for infection of antibiotics
