Prem labour and PPROM Flashcards
Identify risk factors for PPROM and preterm labour
- history of preterm birth
- short cervical length <25mm
- AMA or young MA
- Ethnicity
- ART
- multiple gestations
- PPROM
- stress
- vaginal bleeding
- infection
- short inter pregnancy interval
- smoking, drinking, substance use, low BMI
- presence of fetal fibronectin
Explain the medical management of PPROM
Assessment
- speculum to visualise amniotic fluid or complete amnisure, low and high swabs for GBS
Management determined by:
- gestation
- presence of infection
- advanced labour
- fetal wellbeing
Expectant management - before 34 weeks IOL contraindicated, then balance risks vs benefits
Active management
- considered from 34 weeks if GBS positive
Describe the risks/benefits to mother and foetus re active vs expectant management
Active
Expectant
Explain potential complications associated with PPROM
- preterm birth and its complications
- cord prolapse if waters break before head is low
- sepsis due to long exposure
- placental abruption
- oligohydramnios
Describe the midwifery role in caring for women with PPROM
Assessing woman reporting PPROM
- time of PPROM?
- colour, amount, odour, put a pad in
- is baby moving normally
- are you unwell?
- does she have any complications?
- do you know your GBS status?
- are you contracting?
- DOCUMENT THIS
- maternal and fetal obs
- abdo palp
- if >28 weeks, CTG, otherwise FHR doppler
Monitoring for chorio
- fever
- tender abdo palp
Describe the leading cause of morbidity and mortality for preterm neonates
- Respiratory distress due to immature lung development
- Infection due to immature immune system
- Intraventricular haemorrhage due to incomplete maturation of cerebral blood vessels
Describe the different methods to monitor maternal and fetal wellbeing
Describe the signs and symptoms of preterm labour
- regular uterine contractions
- cervical dilation and/or effacement
- vaginal loss
- presenting part engaged
- back pain
Explain the complications associated with preterm labour
Maternal
- psychosocial impact
Fetal
- increased risk of morbidity and mortality
-
Describe the indication, contraindication, MOA and dose of medications used in preterm labour
Tocolytic - medication used to slow or stop contractions. Typically inhibit labour 24-48 hours. enables transfer and maximum effect of corticosteroids.
CCB eg. Nifedipine
- prevents entry of calcium through cell membranes to inhibit smooth muscle contractions
- Side effects = maternal tachycardia, headache, dizziness
- contraindications = hypotension, certain cardiac conditions
Dose - 20mg, if contractions persist after 30, another 20mg, with a maintenance ever 6 hours for 48hrs
Mag sulf 24-30 WEEKS
- loading dose 4g IV over 20 mins
then 1g/hr IV until 24 hours or birth
- neuroprotection of fetus when birth is anticipated in next 24 hours
Corticosteroids eg. Betamethasone
- Induces pulmonary surfactant in infant lungs to promote maturation
- prevents the 3 highest reasons of morbidity/mortality
- 11.4mg IM, then another in 24 hours
- Consider second dose at 12 hours if birth is likely
- if risk of preterm birth remains ongoing in 7 days repeat 11.4mg
Antibiotics
- prolongs pregnancy and reduces incidence of chorioamnionitis and neonatal sepsis
- administered after PROM
- IV Ben Pen 3g loading and 1.8g every 4 hours
Explain the medical management of preterm labour
For women with a history of preterm birth and short cervical length can consider
- progesterone therapy - suppository
- cervical cerclage - stitching cervix closed mechanically
For a woman presenting with S+S of preterm labour
- speculum to visualise cervix, assess for membranes ruptured, complete fFN, high and low vaginal swab for GBS
- Ultrasound for fetal growth and wellbeing
- FBE
For a woman in preterm labour
- Tocolysis
- IV ben pen
- Betamethasone
- mag sulf if <30 weeks
- prepare for assisted birth or medical birth
- prepare for fetal compromise/distress
Describe the role of the midwife when caring for a woman with premature labour
Antenatal
- identify and escalate women with risk factors
- education on S+S of labour and to call PAU, esp if they appear <37 weeks
- smoking cessation counselling
- refer for cervical cerclage
For a woman presenting with S+S of preterm labour
- review history
- assess for S+S of preterm labour
- vital signs
- abdo palp and CTG
- Urinalysis
For a woman in preterm labour
- transfer if capability is low
- Tocolysis - Nifedipine
- IV ben pen
- Betamethasone
- Mag sulf if <30 weeks
- prepare obs and paeds for birth
- notify NICU and offer tour
- counsel woman re. birth, condition of baby
- if labour proceeds, cease tocolysis
- manage birth as normal
- continuous CTG
- prepare for resus/ transfer to NICU
Define PPROM and Preterm labour
Preterm labour - the spontaneous onset of labour between 20-37 weeks gestation
- early preterm birth 20-34 weeks
- late preterm birth 34-37 weeks
PPROM - the spontaneous rupture of membranes before the onset of labour between 20-37 weeks gestation
Fetal fibronectin
Fetal fibronectin is a protein which helps to attach membranes to uterus during pregnancy
If fFN is measured in amniotic fluid, at risk of delivery in next 7 days
