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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Pregnancy complications - Preterm labour > Flashcards

Pregnancy complications - Preterm labour Flashcards

1
Q

What is preterm birth?

A

Delivery between 24 and 37 weeks

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2
Q

What are risk factors for pre-term labour?

A
  • Uterine factors
    • ​Multiple pregnancy
    • Polyhydramnios
    • APH
  • Cervical factors
    • ​Previous cervical surgery - large LLETZ, trachelectomy
    • Cervical incompetance
  • Maternal factors
    • ​Infection eg UTI
    • Previous pre-term labour
    • Previous PROM
    • Race
    • BMI
    • Age
    • Alcohol
    • Smoking
  • Social factors ​
  • Iatrogenic factors​
    • Severe pre-elcampsia
    • IUD
    • IUGR
  • Idiopathic
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3
Q

How does preterm labour associated with infection/inflammation/abruption tend to present?

A
  • Lower abdominal pain
  • Painful uterine contractions
  • Vaginal loss
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4
Q

What commonly occurs before preterm labour which can indicate that it is about to happen?

A

Spontaneous rupture of membranes (SRM)

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5
Q

What would you want to ask about in the history in someone who is presenting in preterm labour?

A
  • Pain/contractions - onset, frequency, duration, severity
  • Vaginal loss - PV bleeding, SROM
  • Obstetric history
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6
Q

How would you examine someone with acute preterm labour?

A
  • Observations - pulse, RR, Temperature
  • Uterine tenderness
  • Foetal presentation
  • Speculum
  • Gentle VE
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7
Q

What investigations would you consider doing in someone with preterm labour?

A
  • Bedside - Swabs, Dipstick, Foetal CTG
  • Bloods - FBC, CRP, foetal fibronectin
  • Imaging - USS
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8
Q

How would you manage someone in preterm labour?

A
  • Treat cause - may help
  • Admit if high risk and warn neonatal unit
  • Check foetal presentation
  • Consider tocolytic medications
  • IM steroid
  • IV antibiotics
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9
Q

When are tocolytic drugs normally used?

A

Threatened preterm labour for 24-35 weeks

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10
Q

What are the main uses for tocolytics when given to women in preterm labour between 25-37 weeks gestation?

A
  • Facilitate transfer to appropriate facilites
  • Give steroid treatment more time to work
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11
Q

What durgs can be used for tocolysis?

A
  • CCBs - nifedipine
  • Oxytocin receptor antagonists - Atosiban
  • B2 agonists - terbutaline, salbutamol
  • Magnesium sulphate - used for neuroprotection of baby
  • Indomethazin
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12
Q

When is tocolysis indicated for acutely?

A
  • Foetal distress
  • Need for emergency CS
  • Obstructed labour
  • Hypertonic uterus causing foetal distress
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13
Q

What drugs would you use when trying to acutely tocolyse a woman in preterm labour?

A
  • Terbutaline
  • GTN
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14
Q

Why would you give steroids to someone in preterm labour?

A

Reduces rates of:

  • Foetal respiratory distress (matures foetal lungs by increasing surfactant production)
  • Intraventricular haemorrhage
  • Neonatal death

Also closes PDA

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15
Q

What dose of steroids is used in the management of preterm labour?

A

Betamethasone/dexamethasone - 2 x 12mg given 24 hrs apart

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16
Q

Why is it important to start steroids as early as possible in someone in preterm labour?

A

Can take 12-24 hours for the full course therefore it is best to avoid delays in administration

17
Q

When are steroids indicated for in preterm labour?

A
  • Risk of preterm labour
  • Threatened SROM
  • Medical need to expidite delivery
18
Q

What are absolute contraindications to tocolysis?

A
  • Chorioamnionitis
  • Foetal death
  • Condition needing immediate delivery
19
Q

What is foetal fibronectin?

A

A glycoprotein not usually detected in vaginal secretions between 22-36 weeks. It is found in the cervico-vaginal secretions before 21 weeks (so shouldn’t be there after this time). Inflammation/trauma leads to its secretion into the cervix/vagina.

If engative, unlikely to be labour

If positive, high risk of preterm labour.

20
Q

What does a +ve foetal fibronectin indicate?

A

10% risk of preterm pregnancy

21
Q

How would you manage PROM?

A
  • Admit for 48hrs
  • Rule out sepsis/chorioamnionitis
  • Give steroids
  • Give erythromycin (10 days) - reduce neonatal infection without enterocolitis
  • Manage labour - if that is the outcome
  • If no labour in 48hrs - discharge and manage as outpatient
22
Q

What is the biggest risk with PROM?

A

Intrauterine infection - increasing risk as time goes on

23
Q

What is regarded as extremely preterm?

A

<28 weeks

24
Q

What is regarded as very preterm?

A

28-32 weeks

25
Q

What is regarded as moderate to late preterm?

A

32-37 weeks

26
Q

How does infection cause preterm labour?

A

Cytokines stimulate production of uterotonins (MMP→ collagen degradation in cervix, Cox-2→ myometrial contractions. IL1,6 and 8→both)

27
Q

How does abruption cause preterm labour?

A

Generation of thrombin→protease and prostaglandin production

28
Q

How does pathological stretching of the uterus (by things like polyhydramnios, multiple pregnancy etc.) cause preterm labour?

A

Stretch increases oxytocin and prostaglandin release

29
Q

What are tociolytics?

A
30
Q

What are the main differentials for pre-term labour?

A
  • UTI
  • Ligament/pelvic girdle pain
  • Constipation/IBS/Diarrhoea
  • Concealed abruption
31
Q

What are the risks assocaited with preamture labour?

A
  • RDS
  • IVH
  • CP
  • Temperature control
  • Jaundice
  • Infections
  • Visual impiarments
  • Hearing loss
  • NEC
  • Death

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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