Pre-Term Flashcards
What is Preterm delivery?
- Occurs between 24-37weeks
- 5-8% deliveries are preterm
- Spontaneous /iatrogenic –pre eclampsia
complications of preterm labour
Neonatal- • NeonatalSCBUadmission • 20% perinatal mortality • 50%cerebralpalsy • Respiratory distress • Cognitive ad behavioural problems
Long term for baby-
• Chronic lung disease
• Blindness
• Minordisability
Maternal risks-infection • LSCScommon
preterm labour Aetiology
• Lower socioeconomic class • Extremes age • Renal failure • Diabetes • Thyroid disease • Pre-eclampsia • IUGR • Malegender • STs • Bacterialvaginosis Aetiology • Previous cervical surgery • Multiple pregnancy • Uterine abnormalities • UTI • Polyhydramnios • Congenital fetal malformations • APH
MEchanims of preterm labour
- Infection- in 60% of cases
- Bacterial vaginosis is a risk factor
- Trichomonas/chlamydia
- UTI
- Twins- excessive stretching/polyhydramnios
- Iatrogenic in pre-eclampsia
- Placental abruption
- Uterine abnormalities
- Cervical incompetence-painless dilatation of cervix followed by delivery
Prediction of preterm labour
• History-previous history of preterm labour and late miscarriage
Investigations-
• TVS-Cervical length
Prevention of preterm labour
Cervical cerclage- is insertion of one or more sutures in the cervix to strengthen and keep it closed
• 12-14weeks
Progesterone supplementation-
• Vaginal suppositories from early pregnancy • Treat infections
Clinical features of pre term labour
History-painful contractions
• Bleeding
• Fluid loss
• Painless dilatation in cervical incompetence
Examination-
• Fever
• Always check lie and presentation • Dilated cervix on examination
Investigations of preterm labour
- Fetal fibronectin- negative result means preterm delivery in next week is unlikely
- TVS- if cervical length is more than 15mm – delivery unlikely
- Vaginal swabs
- CRP
- WBC
Management of pre term labour
• Steroids- 23-34 weeks
• Give in women who has fibronectin positive and have short
cervix
• Steroids- reduces perinatal morbidity and mortality
• By promoting fetal lung maturity
• Dexamethasone 9.9mg IM 2 doses 24 hrs apart
• Magnesium sulphate- neuroprotective effect if given 12 hours before the anticipated preterm delivery
• 23-34 weeks
what is Tocolysis?
- Delay preterm labour
- Relaxes uterus
- Are given-
- To allow time for steroids to act
- For in utero transfer of the women if no SCBU bed is available • Nifedipine or oxytocin receptor antagonists (atosiban)
What is Chorioamnionitis? how is it treated?
- Infection of inflammation and infection of chorion and amnion • IV antibiotics
- Immediate delivery whatever the gestation
What should be considered during delivery in pre term labour?
- Vaginal delivery
- LSCS for obstetric indications
- Paediatrician should attend the delivery • Forceps is used rather than ventouse
- Have better survival if treated in level 3 neonatal intensive care unit
- Mother should be transferred to level 3 unit for delivery