Pre-term labour Flashcards
What is prematurity?
Birth before 37+0
What is extreme prematurity?
<28 weeks
What is severe prematurity?
28-31+6
What is moderate prematurity?
32-33+6
What is late pre-term?
34-36+6
What is the age of viability?
24 weeks, but if 23+ and 400g, showing signs of life then resus often attempted
What is the incidence?
more than 52,000 in 2012
What is the major long term concequence of prematurity?
neurodevelopmental delay
What are the 4 types of risk factors for Preterm labour and PPROM?
- behavioural and environmental
- demographic
- Medical
- Reproductive
what are the 9 behavioural and environmental risk factors of pre term labour and PPROM?
- 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
What demographic are more likely to go into preterm labour and PPROM? 4
- low socioeconomic status
- <17 y/o or >35 y/o
- ethnicity- from underdeveloped countries
What medical risk factors can cause preterm labour and PPROM? 7
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
What are the reproductive risk factors? 9
- 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
What are the 5 ways to prevent pre-term labour?
- encourage healthy lifestyle
- comprehensive antenatal care
- ongoing risk assessment
- infection screening
- routine msu testing for UTI’s
How do we diagnose preterm labour?
- measurement of cervical length (<15mm high chance)
- fetal fibronectin
What 4 drugs are given in pre-term labour?
Antenatal corticosteroids - beta/dexamethasone
Nifidipine
Magnesium sulfate
Antibiotics
What are corticosteroids for?
26-34/40, makes baby stressed so they produce surfactant to keep lungs inflated
What is nifidipine for?
calcium channel blockers- stops the uterus contracting
What is magnesium sulfate for?
comes from pre-eclampsia as reduces maternal fits- helps baby’s neurodevelopment
How do they monitor the fetus in pre-term labour?
intermittent monitoring because if CTG at 25/40 and abnormal- not going to go to emcs
Do they do delayed cord clamping in pre-term labour?
30 seconds, no more than 3 minutes
What is fetal fibronectin?
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.
What medical options are there for tocolysis?
- atosiban (oxytocin receptor inhibitor)
- ritodrine (betamimetic)
- GTN (glyceryl trinitrate)
- indomethacin
- mag sulf
- nifidipine
Does tocolysis improve outcomes?
there is no evidence to suggest this
Management of continuing preterm labour (5)
- labour care
- stop tocolysis
- borderline viability - early mdt consulting
- continuous ctg
- spontaneous labour is often very rapid even for primigravida
What 3 factors does delivery depend on?
gestation, presentation, fetal condition
What can help avoid delay on the perineum?
instrumental and episiotomy
What are maternal complications of prematurity? 5
- infection
- haemorrhage
- psychological trauma
- DIC (secondary to infection or haemorrhage)
- maternal death
What are the fetal complications of prematurity? 5
RDS Poor temp control poor glucose control infection death
What is the role of the midwife?
- 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
what is a pneumothorax?
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
What is the definition of PPROM?
rupture of membranes before 37 weeks and before the onset of labour
What is the incidence?
2% of pregnancies, 40% of preterm deliveries
What are 6 complications of PPROM?
prematurity sepsis pulmonary hypoplasia cord prolapse malpresentation APH
How do you diagnose PPROM? (4)
- 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
Management of PPROM
- corticosteroids - as for preterm labour
- antibiotics - prophylactic but also infection could have caused ROM
- inpatient vs home care
- timing of delivery
- method of delivery
What antibiotics are given for PPROM?
Erythromycin 250mg QDS for 10 days or until labour
-if unable then penicilin for 10 days
What antibiotics should you not give for PPROM?
augmentin or co-amoxyclav - risk of nec
What inpatient care is given for PPROM?
Temp 4 hourly CTG daily CRP and WCC daily USS for liqour volume, growth and dopplers MSU and H/LVS
What care is given at home for PPROM?
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
What are the advantages of going home after PPROM?
approx 10 fewer hospital days (less cost)
psychosocial benefits for mother
less danger of infection
What are the disadvantages of home care after PPROM?
- deterioration in maternal condition may be missed
- fetal monitoring only twice weekly
What does timing of delivery depend on?
maternal and fetal wellbeing
presentation of baby
What is amnioinfusion?
- 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
