Complicated Pregnancy Flashcards
Obstetric emergencies, Breech presentation, VBAC, Abnormal fetal growth & amniotic fluid volume, Multiple pregnancy, Abnormal labour- prematurity, prolonged, fetal compromise, retained placenta, Maternal mental health problems, Ethics
What is the definition of prematurity?
Prematurity is defined as birth before 37 weeks gestation. The more premature the baby, the worse the outcomes.
What is the survival rate of babies born at 23 weeks?
10% chance of survival
Below how many weeks gestation are babies considered to be “non-viable”?
below 23 weeks gestation
What is the survival rate of babies born at 23 weeks?
10% chance of survival
From how many weeks is resuscitation offered for premature babies?
From 24 weeks onwards
Prematurity
How many weeks gestation is classified by the WHO as extreme preterm?
Under 28 weeks
Prematurity
How many weeks gestation is classified by the WHO as very preterm?
28-32 weeks
Prematurity
How many weeks gestation is classified by the WHO as moderate to late preterm?
32-37 weeks
What are prophylaxis methods of preterm labour?
- Vaginal Progesterone
- Cervical Cerclage
How does vaginal progesterone act as a prophylaxis for preterm labour?
Progesterone has a role in maintaining pregnancy and preventing labour by decreasing activity of the myometrium and preventing the cervix remodelling in preparation for delivery.
How is vaginal progesterone given for prophylaxis of preterm labour?
Progesterone can be given vaginally via gel or pessary as prophylaxis for preterm labour.
To which women is vaginal progesterone offered as a prophylaxis of preterm labour?
It is offered to women with a **cervical length less than 25mm **on vaginal ultrasound between 16 and 24 weeks gestation.
What is cervical cerclage?
Cervical cerclage involves putting a stitch in the cervix to add support and keep it closed. This involves a spinal or general anaesthetic. The stitch is removed when the woman goes into labour or reaches term.
To whom is cervical cerclage offered to as a prophylaxis for preterm delivery?
Cervical cerclage is offered to women with a cervical length less than 25mm on vaginal ultrasound between 16 and 24 weeks gestation, who have had a previous premature birth or cervical trauma (e.g. colposcopy and cone biopsy).
When is “Rescue” cervical cerclage offered?
“Rescue” cervical cerclage may also be offered between 16 and 27 + 6 weeks when there is cervical dilatation without rupture of membranes, to prevent progression and premature delivery.
Definition
Preterm prelabour rupture of membranes (P‑PROM):
The amniotic sac has ruptured, releasing amniotic fluid, before the onset of labour and before 37 weeks gestation (preterm).
How is P-PROM diagnosed?
By speculum examination revealing pooling of amniotic fluid in the vagina.
No further tests are required unless there is doubt about the diagnosis.
Where there us doubt about a diagnosis of P-PROM, what tests can be performed?
- Insulin-like growth factor-binding protein-1 (IGFBP-1) is a protein present in high concentrations in amniotic fluid, which can be tested on vaginal fluid if there is doubt about rupture of membranes
- Placental alpha-microglobin-1 (PAMG-1) is a similar alternative to IGFBP-1
Management of P-PROM
- Prophylactic antibiotics should be given to prevent the development of ** chorioamnionitis**. The NICE guidelines (2019) recommend erythromycin 250mg four times daily for ten days, or until labour is established if within ten days.
- Induction of labour may be offered from 34 weeks to initiate the onset of labour.
What is Preterm Labour with Intact Membranes?
Preterm labour with intact membranes involves regular painful contraction and cervical dilatation, without rupture of the amniotic sac.
How is Preterm Labour with Intact Membranes diagnosed?
Clinical assessment includes a speculum examination to assess for cervical dilatation.
NICE Guidlines recommend:
* Less than 30 weeks gestation, clinical assessment alone is enough to offer management of preterm labour.
* More than 30 weeks gestation, a transvaginal ultrasound can be used to assess the cervical length. When the cervical length on ultrasound is less than 15mm, management of preterm labour can be offered. A cervical length of more than 15mm indicates preterm labour is unlikely.
Premature Labour with Intact Membranes
What is Fetal Fibronectin?
Fetal fibronectin is an alternative test to vaginal ultrasound (in diagnosing premature labour with intact membranes). Fetal fibronectin is the “glue” between the chorion and the uterus, and is found in the vagina during labour. A result of less than 50 ng/ml is considered negative, and indicates that preterm labour is unlikely.
Management options for preterm labour with intact membranes to improve outcomes:
- Fetal monitoring (CTG or intermittent auscultation)
- Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
- Maternal corticosteroids: can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
- IV magnesium sulphate: can be given before 34 weeks gestation and helps protect the baby’s brain
- Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby at birth
What is the action of nifedipine in preterm labour?
nifedipine is a calcium channel blocker that suppresses labour
