Module 5: Preterm, PROM and multiple pregnancy Flashcards

1
Q

What is preterm birth

A

Labour that occurs after 20 weeks’ gestation and before 37 weeks’ gestation

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2
Q

Incidence of preterm birth in Australia

A

In most developed nations 5-10% and has increased to 8.5% in Australia.

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3
Q

Rates of morbidity with preterm birth

A

75-85%, 2/3 of perinatal deaths

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4
Q

How does infection affect preterm labour

A

Inflammatory cytokines or bacterial endotoxins can stimulate prostaglandin release directly or indirectly by stimulating the release of cortiocotrophin-releasing hormone.

Infection may be predictive of preterm birth at least 40% of the time

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5
Q

Risk factors for preterm birth

A
  • Demographic: Higher incidence among low socioeconomic, poor education and poverty
  • Past obstetric history. Risk after one 15%, two 41%
  • Women >34 years
  • Medical conditions: diabetes, hypertension, heart disease
  • Current pregnancy: pre-eclampsia, major birth defects, placental abruption
  • Behavioral: stress, psychological issues
  • Environmental
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6
Q

Known causes of preterm birth

A
  • Multiple pregnancy
  • Short pregnancy interval
  • Polyhydramnios
  • Infections
  • Births following ART and ovulation induction.
  • Incompetent’ weak cervix
  • Premature separation of placenta
  • Excessive use of alcohol, smoking and narcotics
  • APH
  • 40-50% have no obvious cause
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7
Q

Cervical assessment

A

Used when women have a history of preterm birth, second trimester miscarriages, current risk of preterm birth, twins and those who have had cervical surgery

Ultrasound surveillance of the length of the cervix to check for shortening and dilatation

Assessment by experienced sonographers to determine in a cerclage is warranted.

Intervention may be required in cervix is <25 mm.

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8
Q

Fetal fibronectin testing

A

fFN is a glycoprotein localised at the maternal-fetal interface of the amniotic membranes. In normal conditions fFN is found in very low levels. Levels >50ng/ml at or after 22 weeks have been associated with an increased risk of preterm birth. fFN is one of the best predictors so far.

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9
Q

Fetal fibronectin testing indications

A
  • Singleton pregnancy
  • 24-34 weeks gestation
  • TPL - regular uterine contractions >6 per hour and/or pelvic pressure.
  • High risk of preterm delivery
  • Intact membranes
  • Cervix <3cm dilatation and no cerclage
  • Established fetal wellbeing
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10
Q

Negative fetal fibronectin meaning

A

Woman is unlikely to deliver within the next 7-10 days with a 95% probability

Avoid unnecessary hospitalization, testing and reduces interventions/costs.

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11
Q

Tocolytic therapy

A

The attempt to stop or limit uterine contractions in preterm labour

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12
Q

Tocolytic drugs

A

Betamimetics eg IV salbutamol, terbutaline and ritodrine relax smooth muscle cells. Causes rapid pulse, chest pain, headaches. Contraindicated in cardiac disease

Calcium channel blockers e.g. oral nifedipine reduce muscle contraction by controlling the influx of calcium across the plasma membrane.

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13
Q

MgSO4 indications

A
  • Preterm fetus <30 weeks
  • Preterm birth expected in <24 hours, treatment to commence as close as 4 hours before
  • 4g loading dose and titrated
  • Used for singleton or twin pregnancies
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14
Q

MgS04 use

A

For neuroprotection of the preterm infant to minimise the risk of cerebral palsy

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15
Q

S/S of premature labour

A

Cervix begins to efface and dilate
Contractions that occur every 6-10 minutes that lasts for 30 seconds for at least an hour.

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16
Q

Contraindications to preventing preterm labour

A
  • Mature fetus >34 weeks
  • Fetal death
  • Fetal anomaly incompatible with life
  • SGA/IUGR related to unfavorable intrauterine environment
  • Other fetal compromise/fetal distress
  • Active hemorrhage
  • Intra-amniotic infection/chorioamnionitis
17
Q

Labour management for preterm birth

A

Tocolysis if applicable
Consider hospital location
Careful assessment and triage
Commence IMI steroids
Notify NICU/SCN
Multidisciplinary team management
Room set-up
Usual labour observations and cares
Education, reassurance and support
Possible fetal distress, malpresentations, cord involvement

18
Q

Premature rupture of membranes: Definition and incidence

A

Rupture of the amniotic sac prior to 37 completed weeks gestation.

1-4% of all pregnancies. 25% of preterm births.

19
Q

PROM maternal and fetal effects

A

Maternal:
* 50% will deliver within 1 week
* Maternal sepsis can be overwhelming
* Disruption with hospitalization

Fetal:
* Prematurity
* Fetal infection
* Fetal compromise
* Developmental abnormalities

20
Q

PROM diagnosis

A

No vaginal examination
Sterile speculum examination
Amnicator test
Corticosteroids now routinely given with PROM
Observe for signs of labour

21
Q

PROM management

A

In the absence of infection or fetal compromise expectant management and surveillance is indicated.
Prophylactic antibiotics
Serial U/S
Pad charts and checks
Daily CTG

22
Q

Incidence of twins/triplets

A

1.4% of all births
1:80 Caucasian pregnancies, 1 in 44 west African pregnancies, lowest rates in Asia

23
Q

Diagnosis of twins

A

Clinical findings: suspected on history and clinical examination.
Confirmed by U/S

24
Q

Complications of multiple pregnancy

A

Anaemia
Placenta previa
Polyhydramnios and preterm labour
Malpresentation
Pre-eclampsia
Gestational diabetes
Postpartum hemorrhage
Growth restriction
Intrauterine death
Twin-twin transfusion syndrome