Pre-Term + Maternal Infection Flashcards
What is term
37 weeks - 41
What is preterm
Onset <37 weeks
Mild
32-36
Serious
28-32
What is extreme
24-28 weeks
What is ddx of pre-term labour
UTI Pelvic girdle pain Braxton Hix Constipation IBS Diarrhoea Concealed abruption
What can cause pre-maturity
Spontaneous / idiopathic = most common Induced for maternal / fatal reasons - PET / DM Endocrine Overdistension - poly / twins / deformity Uterine abnormality Cervical disease / malformation APH - any Ischaemia Infection Smoking Malnutrition Allograft reaction Allergic
RF for pre-term
Previous pre-term PPROM Vaginal bleed Short Cervix Previous LLETZ Smoking Small baby Abnormal lie
When is LLETZ CI
Women who still want children due to risk
How do you Dx pre-term labour
Contractions + cervical change on VE
What do you do if high risk of pre-term
USS to look for cervical length
FFN
Avoid regular VE
What is FFN
Glycoprotein in vaginal secretion
10% go into early labour if +Ve
How do you prevent pre-term
Vaginal progesterone if short cervix found on USS <25mm
Cervical cerclage if Hx of PPROM or trauma - requires GA to put stitch which is removed before labour
Treat any infection
How do you assess suspected pre-term
Speculum and VE to see if os open
Blood and urine and swab to look of rinfection
USS
CTG
What do you do if FFN +Ve
2 doses IM steroids - dexamethasone
Monitor BM as steroid = hyper
If pre-term labour established what do you do
Analgesia
Tocolysis to allow steroid and transfer
Steroid - 2 doses 24 hours apart (dexamethasone)
May be enough to prevent progression if membranes haven’t ruptured
Mg sulphate to prevent cerebral palsy - used if within 24 hours of delivery and <34 weeks Require close monitoring for toxicity Ax for all pre-term baby Ax in labour for all pre-term Transfer to NICU unit Aim for vaginal birth
Complications of prematurity
NEC IRDS IVH HEC Cerebral pals Temp control Jaudnice Infection REtinopathy Nutrition / poor feeding
What is PPROM
Rupture of membranes without contractions or intiiation of labour
May present with incontinence / low AFI
What are RF for PPROM
Same risk as pre-term
Short cervix
Abnormal lie
How do you Dx
Sterile speulum
IGF binding protein / alpha-microglobulin
- present in vaginal fluid if waters have broken
NO VE as risk of infection
USS for oligohydramnio
How do you treat PPROM
Admit 48 hours
Monitor for labour / infection
Give 10 days Ax to prevent chorioamnitis
Steroid - dexamethasone
Send home and monitor temperature every 4-8 hours
Mg sulphate if delivery within 24 hours
When do you deliver after PPROM
34 weeks as infection risk too high after this
What Ax
Erythromycin
What are complications of PPROM
Premature Infection CHorioamnitis Vasa praevia Pulmonary hypoplasia
What is chorioamnitis
Infection due to ascending bacterial of amniotic fluid / membrane or placenta
Usually after PPROM but can happen with intact membrane
How does chorioamnitis present
Tender uterus Rupture Foul odour Pyrexia Abdominal pain Signs of sepsis - tachy, hypo (may be only sign) Leucocytosis / nitrites on dip etc
How do you treat
URGENT referral IV Ax Prompt C-section Sepsis 6 IV Ax
What is puerperal pyrexi
Temp >38 in first 14 days post partum
What are the causes
Endometritis UTI WOund infection Mastitis VTE
How do you treat
Admit to hospital
IV Ax
What is PROM
Pre-labour rupture of membrane in term
What do you do
Watch and wait
Most go into labour within 24 hours
What do you do if >24 hours
May think about Ax to prevent chorioamnitis
Give intra-partum Ax when in labour
When does endometritis tend to occur
Post-partum
