Prematurity Flashcards
What is prematurity defined as?
Prematurity is defined as birth before 37 weeks gestation. The more premature the baby, the worse the outcomes. Resuscitation in babies under 500 grams or 24 weeks gestation should be carefully considered, as outcomes are likely to be very poor.
The WHO classify prematurity as:
Under 28 weeks: extreme preterm
28 – 32 weeks: very preterm
32 – 37 weeks: moderate to late preterm
Risk factors prematurity?
Social deprivation Smoking Alcohol Drugs Overweight or underweight mother Maternal co-morbidities Twins Personal or family history of prematurity
Management of prematurity before birth?
There is a dramatic improvement in prognosis with each additional week of gestation, particularly in very premature babies. In women with a history of preterm birth or an ultrasound demonstrating a cervical length of 25mm or less before 24 weeks gestation there are two options of trying to delay birth:
Prophylactic vaginal progesterone: putting a progesterone suppository in the vagina to discourage labour
Prophylactic cervical cerclage: putting a suture in the cervix to hold it closed
Where preterm labour is suspected or confirmed there are several options for improving the outcomes:
Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
Maternal corticosteroids: can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
IV Magnesium sulphate: can be offered before 34 weeks gestation and helps protect the baby’s brain
Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby
Complications of prematurity?
Issues In Early Life
Respiratory distress syndrome Hypothermia Hypoglycaemia Poor feeding Apnoea and bradycardia Neonatal jaundice Intraventricular haemorrhage Retinopathy of prematurity Necrotising enterocolitis Immature immune system and infection
Long Term Effects
Chronic lung disease of prematurity (CLDP)
Learning and behavioural difficulties
Susceptibility to infections, particularly respiratory tract infections
Hearing and visual impairment
Cerebral palsy
