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Year 4 - Obstetrics > Premature Labour > Flashcards

Premature Labour Flashcards

1
Q

What is premature labour?

A

The presence of contractions of sufficient length and frequency to effect progressive effacement of and dilation of the cervix before 37 weeks gestation

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2
Q

How many babies are born prematurely in the UK every year?

A

~60,000

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3
Q

What is considered a very premature birth?

A

Less than 32 weeks gestation

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4
Q

What % of UK births are very premature?

A

1.4%

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5
Q

What % of infant deaths are in very premature babies?

A

51%

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6
Q

What proportion of premature births have no known cause?

A

30%

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7
Q

What % of premature births are due to multiple pregnancy?

A

30%

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8
Q

What are some other risk factors for premature labour?

A
  • Genital tract infection
  • Bacterial vaginosis
  • Antepartum haemorrhage
  • Antepartum haemorrhage
  • Cervical incompetence
  • Congenital uterine abnormalities
  • Antiphospholipid syndrome
  • DM
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9
Q

What is a common presenting symptom of premature labour?

A

Painful contractions before 37 weeks

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10
Q

What are many of the women experiencing when they have early painful contractions?

A

Braxton Hicks contractions

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11
Q

What percentage of women who present with early onset painful contractions have NOT delivered within 48 hours?

A

60%

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12
Q

What are some factors that indicate a woman has gone into true labour early?

A
  • Cervical dilatation and effacement
  • Vaginal bleeding in third trimester
  • Heavy pressure in pelvis
  • Abdominal or back pain
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13
Q

What ma indicate premature rupture of membranes?

A

A watery discharge from the vagina

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14
Q

When do women with suspected pre-term labour not require further investigations?

A

Under 29+6 weeks with intact membranes

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15
Q

When do women with intact membranes and are suspected to be in preterm labour require investigation?

A

When 30 weeks or greater

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16
Q

What investigations can be used to assess for preterm labour?

A
  • Transvaginal USS measurement of cervical length
  • Fetal fibronectin
  • Vaginal swab
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17
Q

Why is transvaginal assessment of cervical length useful in assessing possible preterm labour

A

It estimates the likelihood of delivery within 48 hours

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18
Q

What finding on transvaginal ultrasound suggests preterm labour unlikely?

A

Cervix >15mm length

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19
Q

When should fetal fibronectin be used as an investigation for preterm labour?

A

As a quick and simple alternative to transvaginal ultrasound

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20
Q

What does fetal fibronectin require to be reliable?

A

Internal examination not to have been done first

21
Q

What fetal fibronectin result is not indicative of preterm labour?

A

<50ng/ml

22
Q

How is fetal fibronectin tested?

A

A swab is taken from near the cervix

23
Q

Why should vaginal swabs be taken of all women with suspected preterm labour?

A

So appropriate antibiotic therapy can be given if infection develops

24
Q

What is the priority once preterm labour has been established?

A

Ensure mother is taken safest available facility for delivery of a pre-term infant

25
Q

What medications may need to be given to women in preterm labour?

A
  • Tocolytic drugs
  • Corticoteroids
  • Magnesium sulphate
26
Q

What are tocolytic agents?

A

Drugs that reduce contractions

27
Q

Who is most likely to benefit from tocolysis in preterm labour?

A
  • Very pre-term
  • Thos needing transfer to hospital with neonatal unit
  • Those hot yet completed corticosteroids
28
Q

What is essentially the benefits of tocolysis?

A

It basically gives more time to prepare and ensure baby is delivered as late and with the best chance of survival possible

29
Q

When should tocolytics not be used?

A

When there is P-PROM

30
Q

What is the first line tocolytic drug?

A

Nifedipine

31
Q

What is the second line tocolytic drug?

A

Oxytocin receptor antagonist e.g. atosiban

32
Q

When should maternal corticosteroids be used in preterm labour?

A

If gestation is between 24 and 35+6 weeks

33
Q

Why are antenatal steroids used in preterm labour?

A

They are associated with significant reduction in neonatal deaths, RDS and intraventricular haemorrhage

34
Q

When are benefits of corticosteroids used for preterm labour seen?

A

Within 24 hours of the first dose

35
Q

What should dosing regimes of antenatal corticosteroids provide?

A

24mg of betamethasone or dexamethasone IM over a 24 to 48 hour period

36
Q

What is the relevance of magnesium sulphate in preterm labour?

A

It reduces the risk of cerebral palsy

37
Q

Who should receive antenatal magnesium sulphate in preterm labour?

A

Women who are between 24 and 29+6 weeks and are expecting to deliver within 24 hours

38
Q

Who can be considered for antenatal magnesium sulphate?

A

Women who are 30-33+6

39
Q

How is antenatal magnesium sulphate given?

A

As a 4g IV bolus followed by an infusion 1g/hour over 24 hours or until delivery

40
Q

What monitoring is required for magnesium sulphate?

A

Magnesium toxicity

41
Q

When should emergency cervical cerclage be considered in preterm labour?

A

Women between 16 and 34 weeks with dilated cervix and exposed unruptured membranes

42
Q

What is cervical cerclage?

A

The cervix sewn closed or partially closed

43
Q

What are the contra-indications for cervical cerclage?

A
  • Signs of infection
  • Any bleeding
  • Uterine contractions
44
Q

How are most pre-term babies delivered if they are cephalic in presentation?

A

Vaginally

45
Q

How are breech babies before 32 weeks delivered?

A

C-section

46
Q

What monitoring is required during labour of a premature baby?

A

Fetal heart rate

47
Q

How can fetal heart rate be monitored during delivery in a premature baby?

A
  • External ultrasound (CTG)

- Intermittent auscultation

48
Q

What is the prognosis of a baby born after 30 weeks with optimal care?

A

Most survive without any long lasting complications

49
Q

What is prognosis of a baby born before 27 weeks linked to?

A

Gestational age

Year 4 - Obstetrics (61 decks)

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