Pre-term Labour Flashcards
define term
37 to 42 weeks
define EDD
40 wks
define pre term
<37 wks
what % births are preterm
8
what % of preterm births are elective
25
reasons for intentionally delivering someone preterm
PET
IUGR
define labour
regular contractions of uterus resulting in changes of cervix
define extreme pre term
<28 wks
define very preterm
28-32 wks
define late to moderate preterm
32 to 37 wks
when does all morbidity fall in terms of wks of gestation
32 weeks onwards
preterm labour Ix
Hx
speculum / bimanual
USS
TVUSS - cervical lengthening
CTG (contractions)
preterm labour RFs
prev preterm
twins
genital tract infections
PPROM
uterus issues - eg bicornate
cervix issues - eg LLETZ
placental issues
smoking, stress
Sx of preterm labour
dull backache
abdo tightenings
lower abdo pressure
PVB or spotting
PROM - gush or trickle
when should preterm labour be Tx (wks)
<29+6 wks
or >30 wks
why is TVUS done in preterm labour
determine cervical length - very hard
what is foetal fibronectin used for
to rule out preterm labour if its negative
what does a positive foetal fibronectin indicate
nothing, can be false positive
what causes a false positive of foetal fibronectin
sex
ROM
PVB
what does a negative foetal fibronectin indicate
unlikely to start labour in 14 days
what % of term vs preterm births have PPROM
3% term 30-40% preterm
complications associated with PPROM
neonatal sepsis
cord prolapse
lung hypoplasia
what is the average time from PPROM to birth
7 days
Ix for PPROM
speculum - look for fluid
USS estimation of amniotic fluid if neg
what result is diagnostic for PPROM
squirt of fluid out of cervix upon coughing in speculum exam
Mx of PPROM inc specific drug, dose, freq & when to stop
oral ABx prophylaxis
- erythromycin 250mg 4x daily until labour or 10 day course
what ABx should not be given for PPROM prophylaxis and why
co-amoxiclav - increased NEC risk
what condition is there a risk of with PPROM & how is this monitored for
chorioamnionitis
CRP or temp
when should steroids be given in PPROM
24 to 34 weeks
when should tocolytics be considered for PPROM
benefit of maternal steroids
when should tocolytics NOT be used in PPROM
foetal distress
APH
PET
types of tocolytics indicated in PPROM
nifedipine (CCB)
atosiban (oxytocin antagonist)
which steroids are given in PPROM
betamethasone or dexamethasone
why are betamethasone / dexamethasone used in PPROM vs other steroids
cross placenta
no mineralocorticoid effect
dose / route / freq of steroids in PPROM ?
12mg IM x2, 12 or 24 hours apart
then again after 2-7days
purpose of MgSO4 in preterm labour
neuroprotective for preterm babies
dose of MgSO4 for preterm labour
4g IV bolus over 15 mins
for what is vaginal progesterone / cervical cerclage offered
preterm labour
2nd trimester miscarriage
cervical length <25mm in wks 16-24
how does progesterone affect pregnancy
maintains the pregnancy through uterine quiescence
when is cervical cerclage done
12 to 14 wks
rescue clerage done 23 wks
what is cervical cerclage
stitching up cervix to narrow cervical os
when is cervical cerclage removed
37 weeks
