Premature Labour Flashcards
What is premature labour?
The presence of contractions of sufficient length and frequency to effect progressive effacement of and dilation of the cervix before 37 weeks gestation
How many babies are born prematurely in the UK every year?
~60,000
What is considered a very premature birth?
Less than 32 weeks gestation
What % of UK births are very premature?
1.4%
What % of infant deaths are in very premature babies?
51%
What proportion of premature births have no known cause?
30%
What % of premature births are due to multiple pregnancy?
30%
What are some other risk factors for premature labour?
- Genital tract infection
- Bacterial vaginosis
- Antepartum haemorrhage
- Antepartum haemorrhage
- Cervical incompetence
- Congenital uterine abnormalities
- Antiphospholipid syndrome
- DM
What is a common presenting symptom of premature labour?
Painful contractions before 37 weeks
What are many of the women experiencing when they have early painful contractions?
Braxton Hicks contractions
What percentage of women who present with early onset painful contractions have NOT delivered within 48 hours?
60%
What are some factors that indicate a woman has gone into true labour early?
- Cervical dilatation and effacement
- Vaginal bleeding in third trimester
- Heavy pressure in pelvis
- Abdominal or back pain
What ma indicate premature rupture of membranes?
A watery discharge from the vagina
When do women with suspected pre-term labour not require further investigations?
Under 29+6 weeks with intact membranes
When do women with intact membranes and are suspected to be in preterm labour require investigation?
When 30 weeks or greater
What investigations can be used to assess for preterm labour?
- Transvaginal USS measurement of cervical length
- Fetal fibronectin
- Vaginal swab
Why is transvaginal assessment of cervical length useful in assessing possible preterm labour
It estimates the likelihood of delivery within 48 hours
What finding on transvaginal ultrasound suggests preterm labour unlikely?
Cervix >15mm length
When should fetal fibronectin be used as an investigation for preterm labour?
As a quick and simple alternative to transvaginal ultrasound
What does fetal fibronectin require to be reliable?
Internal examination not to have been done first
What fetal fibronectin result is not indicative of preterm labour?
<50ng/ml
How is fetal fibronectin tested?
A swab is taken from near the cervix
Why should vaginal swabs be taken of all women with suspected preterm labour?
So appropriate antibiotic therapy can be given if infection develops
What is the priority once preterm labour has been established?
Ensure mother is taken safest available facility for delivery of a pre-term infant
