Pre-Term Flashcards

1
Q

What is Preterm delivery?

A
  • Occurs between 24-37weeks
  • 5-8% deliveries are preterm
  • Spontaneous /iatrogenic –pre eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

complications of preterm labour

A
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

preterm labour Aetiology

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MEchanims of preterm labour

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prediction of preterm labour

A

• History-previous history of preterm labour and late miscarriage
Investigations-
• TVS-Cervical length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prevention of preterm labour

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical features of pre term labour

A

History-painful contractions
• Bleeding
• Fluid loss
• Painless dilatation in cervical incompetence
Examination-
• Fever
• Always check lie and presentation • Dilated cervix on examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations of preterm labour

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of pre term labour

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is Tocolysis?

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Chorioamnionitis? how is it treated?

A
  • Infection of inflammation and infection of chorion and amnion • IV antibiotics
  • Immediate delivery whatever the gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be considered during delivery in pre term labour?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly