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Obs & Gynae > Pre-Term + Maternal Infection > Flashcards

Pre-Term + Maternal Infection Flashcards

1
Q

What is term

A

37 weeks - 41

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2
Q

What is preterm

A

Onset <37 weeks

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3
Q

Mild

A

32-36

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4
Q

Serious

A

28-32

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5
Q

What is extreme

A

24-28 weeks

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6
Q

What is ddx of pre-term labour

A 
UTI
Pelvic girdle pain 
Braxton Hix
Constipation
IBS
Diarrhoea
Concealed abruption
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7
Q

What can cause pre-maturity

A 
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
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8
Q

RF for pre-term

A 
Previous pre-term
PPROM 
Vaginal bleed
Short Cervix
Previous LLETZ 
Smoking 
Small baby
Abnormal lie
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9
Q

When is LLETZ CI

A

Women who still want children due to risk

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10
Q

How do you Dx pre-term labour

A

Contractions + cervical change on VE

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11
Q

What do you do if high risk of pre-term

A

USS to look for cervical length
FFN
Avoid regular VE

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12
Q

What is FFN

A

Glycoprotein in vaginal secretion

10% go into early labour if +Ve

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13
Q

How do you prevent pre-term

A

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

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14
Q

How do you assess suspected pre-term

A

Speculum and VE to see if os open
Blood and urine and swab to look of rinfection
USS
CTG

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15
Q

What do you do if FFN +Ve

A

2 doses IM steroids - dexamethasone

Monitor BM as steroid = hyper

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16
Q

If pre-term labour established what do you do

A

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
17
Q

Complications of prematurity

A 
NEC
IRDS
IVH
HEC
Cerebral pals
Temp control
Jaudnice
Infection 
REtinopathy 
Nutrition / poor feeding
18
Q

What is PPROM

A

Rupture of membranes without contractions or intiiation of labour

May present with incontinence / low AFI

19
Q

What are RF for PPROM

A

Same risk as pre-term
Short cervix
Abnormal lie

20
Q

How do you Dx

A

Sterile speulum
IGF binding protein / alpha-microglobulin
- present in vaginal fluid if waters have broken
NO VE as risk of infection
USS for oligohydramnio

21
Q

How do you treat PPROM

A

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

22
Q

When do you deliver after PPROM

A

34 weeks as infection risk too high after this

23
Q

What Ax

A

Erythromycin

24
Q

What are complications of PPROM

A 
Premature
Infection
CHorioamnitis
Vasa praevia
Pulmonary hypoplasia
25
Q

What is chorioamnitis

A

Infection due to ascending bacterial of amniotic fluid / membrane or placenta
Usually after PPROM but can happen with intact membrane

26
Q

How does chorioamnitis present

A 
Tender uterus
Rupture
Foul odour
Pyrexia
Abdominal pain 
Signs of sepsis - tachy, hypo (may be only sign) 
Leucocytosis / nitrites on dip etc
27
Q

How do you treat

A 
URGENT referral 
IV Ax 
Prompt C-section
Sepsis 6 
IV Ax
28
Q

What is puerperal pyrexi

A

Temp >38 in first 14 days post partum

29
Q

What are the causes

A 
Endometritis 
UTI
WOund infection
Mastitis
VTE
30
Q

How do you treat

A

Admit to hospital

IV Ax

31
Q

What is PROM

A

Pre-labour rupture of membrane in term

32
Q

What do you do

A

Watch and wait

Most go into labour within 24 hours

33
Q

What do you do if >24 hours

A

May think about Ax to prevent chorioamnitis

Give intra-partum Ax when in labour

34
Q

When does endometritis tend to occur

A

Post-partum

Obs & Gynae (23 decks)

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