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Women's health > Fetal medicine > Flashcards

Fetal medicine Flashcards

1
Q

What is Pre-Term-Labor (PTL)?

A

PTL is labour that occurs before 37 weeks’ gestation

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2
Q

What is threatened labor ?

A

It is labor that occurs prior to 24 weeks.

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3
Q

PTL ultimately ending with preterm birth (PTB) accounts for the majority of _______in normally-formed infants

A

perinatal morbidity

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4
Q

What are the causes for Iartogenic PTB?

A

Pre-eclampsia

Intrauterine Growth Restriction (IUGR)

Maternal disease necessitating delivery

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5
Q

What are the spontaneous causes of PTB?

A

Preterm labour (PTL)

Preterm premature rupture of the membranes (PPROM)

Cervical incompetence

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6
Q

What are the non- pregnancy related risk factors for PTB?

A

Low socio-economic group
Extremes of age
Poor nutritional status
Smoking
Drug abuse

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7
Q

What are the pregnancy related risk factors for PTB?

A

Multiple pregnancy
PPROM
Uterine anomalies
History of preterm delivery in prior pregnancy
Placenta praevia
Placental abruption
Polyhydramnios
Medical complications of pregnancy e.g. PET
Intrauterine infection

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8
Q

What is the marker of PTB between 23-35 weeks of gestation?

A

Positive Fetal Fibronectin in cervicovaginal swab. It has high negative predictive value as its absence suggest <1% chance or PTB.

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9
Q

What is the relationship b/w cervix length and PTB?

A

The shorter the cervix the higher the risk of PTB which can be measured through transvaginal US.

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10
Q

Short cervix _____ predicts 75% cases PTB

A

(<25mm)

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11
Q

Weekly IM injections of ______reduced incidence of recurrent PTB by 1/3 in patients with prior PTB

A

17α-hydroxyprogesterone caproate

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12
Q

What is the indication for cervical Cerclage in high risk cases for PTB?

A

*Short cervix found on transvaginal ultrasound <20 weeks
*Prior early PTB
*Cervical incompetence (silent dilation of cervix leading to prior pregnancy loss <20 weeks)

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13
Q

What are the clinical indications of PTL ?

A

Regular painful contractions <37 weeks+ Cervical change+ Cervical dilation.

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14
Q

What are the management options in PTL ?

A
  1. Administer antenatal corticosteroids (Dexamethasone 6mg 12 hourly x 4 doses)
  2. Tocolysis
  3. MgSO4 if delivery imminent <32 wks
  4. Transfer to tertiary level NICU
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15
Q

Antenatal Corticosteroids should be administered between ______ in any case of anticipated preterm birth (e.g. threatened preterm labour)

A

24 and 37 weeks

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16
Q

What are the benefits of corticosteroids in PTL?

A

*Reduction in neonatal mortality
*Reduction in Respiratory Distress Syndrome.
*Reduction in Intraventricular Haemorrhage.
*Reduction in Necrotising Enterocolitis.
*Benefit occurs after 24 hours, and lasts up to 7 days

17
Q

What are tocolytics and their efficacy in PTL ?

A

These are agents that stop contractions and their effectiveness in PTL is controversial.

18
Q

What are the common tocolytics used in PTL?

A

*Atosiban: oxytocin receptor antagonist (IV)
*Nifedipine: calcium channel blocker (oral)
*Ritodrine or Terbutaline: beta adrenergic agonist (IV)
*Magnesium Sulphate: competitive antagonist to calcium (IV)
*Indomethacin: interferes with prostaglandin synthesis (PR)

19
Q

What is the Role of magnesium sulphate in PTL ?

A
  • MgSO4 has proven neuroprotective effect (NMDA antagonist)
  • RCTs prove 30% to 40% reduction in cerebral palsy
    *
20
Q

How is MgSO4 administered in suspected PTL ?

A

*Give IV Infusion MgSO4 (4g bolus / 2g per hr maintenance) immediately prior to anticipated preterm birth 24-32 wks

21
Q

What are the indications for MgSO4?

A

*Labour < 32 wks (>5cm dilated)
*Severe Preeclampsia being delivered < 32 wks
*Severe IUGR being delivered <32 wks

22
Q

What antibotics Should be administered to all patients with threatened preterm labour prior to 37 weeks’ gestation?

A

3g Benzylpenicillin IV followed by 1.8g 6-hourly (Clindamycin if penicillin allergic)

23
Q

What is the prophylaxis for early onset neonatal Group B Streptococcal meningitis?

A

penicillin

24
Q

What are the neonatal consequences of pre-term birth?

A

*Respiratory distress syndrome (RDS)
*Necrotising enterocolitis (NEC)
*Intraventricular haemorrhage (IVH)
*Periventricular leukomalacia (PVL)
*Sepsis
Patent ductus arteriosus (PDA)
Intellectual impairment / Cerebral palsy and Death

25
Q

What is Preterm Premature Rupture of the Membranes ?

A

rupture of membranes before 37 wks gestation

26
Q

Preterm PROM (PPROM) is ___

A

ROM <37 weeks.

27
Q

Prolonged ROM refers to _____

A

ROM > 24hrs

28
Q

What are the risk factors for PPROM?

A

*Spontaneous / Idiopathic (most cases)
*Infection: Chlamydia, GBS,
*Smoking
*Placental abruption
*PPROM in prior pregnancy
*Incompetent Cervix
*Multiple Pregnancy (twins / triplets)
*Polyhydramnios
Iatrogenic (after amniocentesis)

29
Q

What is the test with high specificity and sensitivity for diagnosing PPROM ?

A

Placental alpha-macroglobulin-1

30
Q

What are the Goals of PPROM Management?

A

*Prolonging gestation for as long as it is safe to do so.
*Monitoring for signs of intrauterine infection
*Promoting lung maturity by administering antenatal corticosteroids
*Optimizing the time and mode of delivery

31
Q

What are the signs of maternal infection in PPROM?

A

*Foul smelling vaginal fluid
*Contractions / preterm labour
*Pyrexia (>38oC)
*Tachycardia (>100bpm)
*Uterine tenderness
*Raised white cell count / c-reactive protein

32
Q

What are the PPROM surveillance factors ?

A

*Maternal signs of infection
*Fetal signs of infection
*Serum markers of infection
*Ultrasound markers of fetal compromise
*Altered biophysical profile (BPP)
CTG abnormalities

33
Q

What are the signs of fetal infection in PPROM?

A

*Fetal tachycardia (>160bpm)
*Non-reactive / reduced variability on CTG
*Alteration in biophysical profile
-Loss of breathing movements
-Decrease in gross body movements

34
Q

What is the management of PPROM?

A

*Admit when viability reached (24 wks)
*Close maternal and fetal surveillance, with at least daily CTG tracing
*Steroids – Dexamethasone x2 over 24 hrs
*Antibiotics - Erythromycin 250mg PO QDS x 10 days prolongs latency until delivery
*MgSO4 – IV infusion if delivery imminent and <32 wks

35
Q

All cases of PPROM should be delivered by __ wks, as there is no benefit to continuing pregnancy beyond this time, while there is considerable risk

A

37

36
Q

What is midterm PPROM?

A

It is rare and occurs between 16 to 24 weeks. It has poor overall prognosis. If there is no infection the survival is 50 to 75% overall.

37
Q

Pulmonary hypoplasia is major complication if _____ present at 18-22 wks

A

anhydramnios and consider pregnancy termination due to high risk of materal infection.

Women's health (10 decks)

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