Prematurity

Question 1

Define premature / moderate-late preterm / very pre-term / extremely pre-term

Answer 1

Premature = Infants born before 37 weeks gestation
Moderate-Late preterm 32-36+6 weeks
Very preterm 28-32 weeks
Extremely preterm <28weeks (<1% in UK, but 51% of infant deaths)

Question 2

Give 5 risks to neonates from being born premature

Answer 2

• Neonatal death
• Respiratory distress syndrome
• Chronic lung disease (Bronchopulmonary dysplasia)
• Intraventricular haemorrhage
• Necrotising enterocolitis
• Sepsis
• Retinopathy of prematurity

Question 3

What is the risk of PPROM (preterm premature rupture of membranes)

Answer 3

Can result in significant neonatal morbidity and mortality, primarily as a result of:
- Prematurity
- SEPSIS and CHORIOAMNIONITIS
- Cord prolapse
- Pulmonary hypoplasia [re. amniotic fluid required for lung maturation]

Question 4

In the absence of fluid on sterile speculum examination, what test can be performed to confirm PPROM?

Answer 4

ActimPROM (Insulin-like growth factor binding protein 1 // IGFBP-1)

Question 5

What is the management of PPROM

Answer 5

Admit for Observation for at least 48-72 hours
o Inform NICU
o If patient is going home, check temperature twice daily

Infection&raquo_space; Prophylactic antibiotic (Erythromycin) for 10 days or until labour
o Monitoring = Temperature, Maternal and Fetal heart rate. CRP + WBC.

Lung maturity&raquo_space; Corticosteroids if between 24-33+6 weeks

Delivery&raquo_space; Expectant management until 37 weeks
o Unless signs of maternal or fetal compromise
o If GBS, consider >34 weeks

Question 6

What is Preterm labour (PTL)?

Answer 6

Labour/regular contractions resulting in changes before 37/40

Question 7

Who is at high risk of Preterm labour (PTL)? (give 2)

What increased monitoring do these high-risk mothers require?

Answer 7

Women with a history of:
- Spontaneous preterm birth
- Mid-trimester loss (16+)
- PPROM
- Cervical trauma

Increased monitoring in the form of:
- TV USS Cervical length
- High vaginal swab

Question 8

What investigations can be performed for Preterm labour (PTL)?

Answer 8

Transvaginal ultrasound scan - to assess cervical length

Bedside tests:
- Fetal fibronectin
- Alternative = Actim partus (Phosphorylated Insulin-like growth factor binding protein 1)

Question 9

What is the management for Preterm labour?

Answer 9

Preterm labour management:

• ADMISSION – Liaise with Neonatology. Transfer to hospital with appropriate neonatal unit if necessary “in utero transfer”.
• Tocolysis – slow down contractions with Nifedipine or Atosiban.
  o Allows time for admission of Steroids or transfer
• Lung maturity (Corticosteroids if <34 weeks)
• Rescue Cerclage (if dilated cervix with exposed fetal membranes <28 weeks, no PPROM, no infection, no contractions)
• In labour:
  o Neuroprotection with Magnesium Sulphate for <34 weeks (reduces risk of Cerebral palsy)
  o Antibiotics
  o Continuous monitoring