Pre-term & GBS Flashcards
What is the main cause of pre-term labour?
Pre-term pre-labour ROM
What week defines PTL?
Birth that occurs between 24-37 weeks
Differentials for abdo pain
PTL
Braxton hicks
Uterine rupture
Placental abruption
Bleeding <24 weeks
Miscarriage
Bleeding >24 weeks
APH
Clinical Features of PTL
SROM
Shortened cervical length
Bleed
Pain
Demographic RFs for PTL
Demographics:
Age <18 or >40
Low SES
Smoking
Narcotics
RFs of current pregnancy for PTL
UTI
Polyhydramnios
Multiple pregnancies
PreviousPTL
Gynae RFs for PTL
Previous cervical surgery (>2 LLETZ, cone biopsy)
Hx of TOP
Short cervix
Cervical incompetence
Causes of PTL (PUMICA)
Placental abruption
Uterine distension
Multiple pregnancy
Infection / Illness
Cervical weakness
Atresia (Fetal GI atresia)
How would you prevent PTL
Cervical suture insertion
Screen + treat for bacterial vaginosis prior to 20 weeks
Address Risk factors
Progesterone - Decreases PTL
Risk of prematurity to newborn (BRITish NINJA)
- TTN
- Bronchopulmonary Dysplasia
- Retinopathy of Prematurity
- Infection/Sepsis
- Neonatal death
- Necrotising enterocolitis
- Jaundice
- IVH
- CP
What would you do in clinical exam of PTL?
Hx - Identify RFs + explore contractions, ROM, bleeding, fetal mvmts
Vitals - infection? Hypotension if APH?
Abdominal exam - Fetal size, presentation, engagement, FHR
Speculum - dilation of cervix? Pooling of amniotic fluid? Blood?
NO DIGITAL EXAM
What investigations should be done?
Bloods: FBC, U&E, CRP, Group & hold
Urinalysis
CTG
Fetal/Transvaginal US - FHR, placental location
Speculum - High vaginal swab, FFN, Amnisure
What is fetal fibronectin?
Glute like protein binding the fetal membranes. Rarely present in vaginal secretions 23-35 weeks.
If positive swab = increased risk of PTB
Management of PTL
Admit, IV cannula, bloods + scans
Inform neonatal team & obstetrician
Steroids
Tocolysis (Nifedipine)
Magnesium sulfate
Abx
Delivery considerations
Why are steroids used in PTL?
Reduces risk of:
NRDS
IVH
NEC
Death
Given 7 days prior to delivery ideally
Contraindications to Tocolysis (HAPPI ChaP)
Severe Hemorrhage
Abruption
Pre-eclampsia
Severe IUGR
Pulmonary HTN
Chorioamnionitis
PPROM
When to give antibiotics in PTL?
GBS prophylaxis if actively in labour
Benefits of corticosteroids
Increase fetal surfactant and accelerates lung maturity
Reduces neonatal death, RDS, necrotizing enterocolitis, IVH, and NICU
Betamethasone
What to give if <32 weeks?
Magnesium sulphate
What to check for in 35-37 weeks?
Screen for GBS
RFs for GBS?
Previous GBS
Prolonged ROM
Preterm prelabour ROM
How is Group B Streptococcus (GBS) managed in patients at risk of preterm labor?
IV benzylP during labour (or clindamycin if allergic).
Treat positive cases or people that have RFs
When to give corticosteroids
Between 24-36 weeks
What is the role of tocolysis in the management of preterm labor?
Prolongs pregnancy by 48 hours which allows for corticosteroids administration and time to cross the placenta
Under what conditions should tocolytic drugs not be administered?
- not ‘’HAPPIE’’ with tocolytics
- Hemorrhage
- Abruption (placenta)
- PET
- Pulmonary HTN
- Intolerance
- Eclampsia
What are common infections associated with an increased risk of preterm birth?
- Bacterial Vaginosis
- Chlamydia
- Gonnorrhea
- UTI
- Trichomonias
Indications for BenzylP (or clindamycin)
- GBS + in labour
- PTL (intrapartum).
- GBS in urine
- GBS in swab
- Prev hx of GBS
- Temp >38 in labour
- > 18 hours with ROM (prolonged)
