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Midwifery Emergencies > Pre-term labour > Flashcards

Pre-term labour Flashcards

1
Q

What is prematurity?

A

Birth before 37+0

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2
Q

What is extreme prematurity?

A

<28 weeks

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3
Q

What is severe prematurity?

A

28-31+6

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4
Q

What is moderate prematurity?

A

32-33+6

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5
Q

What is late pre-term?

A

34-36+6

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6
Q

What is the age of viability?

A

24 weeks, but if 23+ and 400g, showing signs of life then resus often attempted

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7
Q

What is the incidence?

A

more than 52,000 in 2012

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8
Q

What is the major long term concequence of prematurity?

A

neurodevelopmental delay

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9
Q

What are the 4 types of risk factors for Preterm labour and PPROM?

A
  1. behavioural and environmental
  2. demographic
  3. Medical
  4. Reproductive
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10
Q

what are the 9 behavioural and environmental risk factors of pre term labour and PPROM?

A
  • smoking
  • drugs
  • nutrition
  • bmi
  • physically demanding work (more likely to have injury + abruption)
  • prolonged periods of standing / shift work
  • domestic violence/abuse
  • abdo injury
  • stress - release of catecholamines can lead to premature labour
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11
Q

What demographic are more likely to go into preterm labour and PPROM? 4

A
  • low socioeconomic status
  • <17 y/o or >35 y/o
  • ethnicity- from underdeveloped countries
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12
Q

What medical risk factors can cause preterm labour and PPROM? 7

A

Infection (Uti’s)
Diabetes - altered insulin requirement affects placental efficiency
Renal disease
Cardiovascular disease
Hypertension (delivery is only way to reduce)
Antiphospholipid syndrome - can lead to iugr
Psychiatric disorders

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13
Q

What are the reproductive risk factors? 9

A
  • PPROM 2% of all pregnancies- 80% will then deliver
  • placental abruption/pph
  • inadequate antenatal care- low socioeconomic status/extreme lifetstyles
  • multiple pregnancy - uterus stops growing, mcmca twins delivered early to prevent twin-twin transfusion
  • cx abnormalities
  • uterine abnormalities
  • polyhydramnios
  • IUGR
  • history of preterm labour
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14
Q

What are the 5 ways to prevent pre-term labour?

A
  • encourage healthy lifestyle
  • comprehensive antenatal care
  • ongoing risk assessment
  • infection screening
  • routine msu testing for UTI’s
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15
Q

How do we diagnose preterm labour?

A
  • measurement of cervical length (<15mm high chance)

- fetal fibronectin

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16
Q

What 4 drugs are given in pre-term labour?

A

Antenatal corticosteroids - beta/dexamethasone
Nifidipine
Magnesium sulfate
Antibiotics

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17
Q

What are corticosteroids for?

A

26-34/40, makes baby stressed so they produce surfactant to keep lungs inflated

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18
Q

What is nifidipine for?

A

calcium channel blockers- stops the uterus contracting

19
Q

What is magnesium sulfate for?

A

comes from pre-eclampsia as reduces maternal fits- helps baby’s neurodevelopment

20
Q

How do they monitor the fetus in pre-term labour?

A

intermittent monitoring because if CTG at 25/40 and abnormal- not going to go to emcs

21
Q

Do they do delayed cord clamping in pre-term labour?

A

30 seconds, no more than 3 minutes

22
Q

What is fetal fibronectin?

A

Extracellular matric glycoprotein localized at the maternal-fetal interface of the amniotic membrane- between chorion and decidua. If present in cx fluid up to 22/40 then released as indicator of possible delivery.

23
Q

What medical options are there for tocolysis?

A
  • atosiban (oxytocin receptor inhibitor)
  • ritodrine (betamimetic)
  • GTN (glyceryl trinitrate)
  • indomethacin
  • mag sulf
  • nifidipine
24
Q

Does tocolysis improve outcomes?

A

there is no evidence to suggest this

25
Q

Management of continuing preterm labour (5)

A
  • labour care
  • stop tocolysis
  • borderline viability - early mdt consulting
  • continuous ctg
  • spontaneous labour is often very rapid even for primigravida
26
Q

What 3 factors does delivery depend on?

A

gestation, presentation, fetal condition

27
Q

What can help avoid delay on the perineum?

A

instrumental and episiotomy

28
Q

What are maternal complications of prematurity? 5

A
  • infection
  • haemorrhage
  • psychological trauma
  • DIC (secondary to infection or haemorrhage)
  • maternal death
29
Q

What are the fetal complications of prematurity? 5

A 
RDS
Poor temp control
poor glucose control 
infection
death
30
Q

What is the role of the midwife?

A
  • prevention where possible
  • risk assessment
  • early detection
  • assisting and liasing with mdt
  • labour care
  • visit scbu
  • prep parents for delivery
  • assist with resus
  • keep baby warm
  • keep baby warm (neo wrap, hat, radiant heaters)
  • encourage breast milk expression
  • emotional support
31
Q

what is a pneumothorax?

A

a collapsed lung- when air leaks into the space between the lung and chest wall- air pushed on the outside of lung and makes it collapse

32
Q

What is the definition of PPROM?

A

rupture of membranes before 37 weeks and before the onset of labour

33
Q

What is the incidence?

A

2% of pregnancies, 40% of preterm deliveries

34
Q

What are 6 complications of PPROM?

A 
prematurity 
sepsis 
pulmonary hypoplasia 
cord prolapse 
malpresentation 
APH
35
Q

How do you diagnose PPROM? (4)

A
  • positive pool of fluid seen in vagina during sterile speculum
  • microscopic examination for
  • ferning of crystalline pattern of dried amniotic fluid
  • presence of lanugo hair
  • fetal epithelial cells
  • USS for oligo
  • fluid not seen- insulin like growth factor binding protein 1 or placental alpha microglobulin test
36
Q

Management of PPROM

A
  • corticosteroids - as for preterm labour
  • antibiotics - prophylactic but also infection could have caused ROM
  • inpatient vs home care
  • timing of delivery
  • method of delivery
37
Q

What antibiotics are given for PPROM?

A

Erythromycin 250mg QDS for 10 days or until labour

-if unable then penicilin for 10 days

38
Q

What antibiotics should you not give for PPROM?

A

augmentin or co-amoxyclav - risk of nec

39
Q

What inpatient care is given for PPROM?

A 
Temp 4 hourly 
CTG daily 
CRP and WCC daily 
USS for liqour volume, growth and dopplers 
MSU and H/LVS
40
Q

What care is given at home for PPROM?

A 
Temp qds with advice to report abnormal 
No baths, tampons or sex
Information concerning symptoms 
Twice weekly rv in hosp for CTG CRP and WCC 
Fortnightly USS for growth 
Weekly USS for dopplers
41
Q

What are the advantages of going home after PPROM?

A

approx 10 fewer hospital days (less cost)
psychosocial benefits for mother
less danger of infection

42
Q

What are the disadvantages of home care after PPROM?

A
  • deterioration in maternal condition may be missed

- fetal monitoring only twice weekly

43
Q

What does timing of delivery depend on?

A

maternal and fetal wellbeing

presentation of baby

44
Q

What is amnioinfusion?

A
  • process of instilling isotonic liquid into the uterine cavity
  • evidence shows improved umbilical artery pH at delivery and reduction in variable decels
  • resulted in reduction of NND, sepsis, pulmonary hypoplasia, puerperal sepsis

Midwifery Emergencies (7 decks)

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