Pre-Term Labour and Puerperium Flashcards
Define preterm labour
When there is persistent uterine activity and cervical dilation and/or effacement before 37 weeks.
What are 5 things that can be given to a premature baby to increase survival chances?
1) Steroids
2) Surfactant
3) Abx
4) Ventilation
5) Nutrition
What are the main risk factors for a premature baby?
1) Previous pre-term birth
2) Vaginal bleeding
3) Ethnic Group
4) Genital Injections
5) Multiple pregnancies
What is the main route of intrauterine infection?
ASCENDING = Most common
1) Haematogenous: Via placenta
2) Retrograde Seeding via FT
3) Iatrogenic: Following invasive procedures
What else can Pre-term be a complication of?
1) Poor endovascular remodelling
2) Amniocentesis
Define prematurity
Babies born before 37 weeks of age
Which organs does prematurity affect the most?
Lungs and Brain as they develop during 3rd trimester
What is the puerperium?
The period from placental delivery to 6w after birth - the post-natal period.
What are the main endocrine changes happen during puerperium?
1) Reduced placental hormones
2) ^ in prolactin for lactation
What are the main physiological changes in the puerperium?
1) Involution of the uterus.
2) Decidua sheds as lochia.
3) Lactation.
What happens during the involution of the uterus?
1) Muscle ischaemia, phagocytosis and autolysis
2) Involution/return to original
What are the 3 stages of lochia shedding known as?
1) Lochia Rubra
2) Lochia serosa
3) Lochia alba
What is the colostrum and what are its main components?
Colostrum: Breast milk produced at birth
- Vit A, NaCl, Protein rich, AB’s, Lactoferrin, GF’s
Briefly outline the physiology of lactation
1) Baby suckles, impulse to brain, prolactin from APG and lactocytes produce milk
2) Baby keeps suckling, impulse to brain again, oxytocin from PPG and myoepithelial contraction –> Milk ejection
What are the major risks in puerperium?
Sepsis, Severe Haemorrhage, PTE, prolapse, VTE, incontinence, depression
What are the minor risks in puerperium?
Fatigue, infection, haemorrhage, anaemia, back pain, haemorrhoids
Which staff members are part of a post-natal MDT?
1) Midwives
2) Doula
3) BFeed support workers
4) Nurses
Paeds and Obs can both be involved too
What are the 3 main RF for sepsis in pregnancy?
1) Obesity
2) Anaemia
3) Diabetes
4) Amniocentesis/Invasive procedure
What are the main causes of sepsis in pregnancy?
1) Endometriosis
2) Skin infection
3) Pyelonephritis
4) Chorioamnionitis
5) Pneumonia
What is a PPH?
Estimated loss of >500mls blood after birth of baby
What is a major PPH?
> 1500mls blood loss after birth and continued signs of bleed/shock
When is the greatest risk of a VTE? And best treatments?
Immediately post birth in post partum
Treat: LMWH and TED stockings
What are the main RF of VTE?
1) Increasing gestational age
2) Obesity
3) Smoking
4) C Section
5) Fam Hx
6) immobility
7) Multiple pregnancy
8) Previous VTE
Describe the physiology behind a post dural puncture headache?
Accidental dural puncture -> CSF leakage and decreased pressure in fluid around the brain.
