Prematurity Flashcards
What is a premature infant?
Born before 37 weeks gestation
What are causes of premature birth?
Multiple pregnancy Antepartum hearmorrhage Cervical impotence Chorioamnionitis Uterine abnormalities Diabetes Polyhydramnios Pyelonephritis Other infections Unknown cause
What are risk factors for prematurity?
Previous preterm birth Multiple pregnancy Cervical surgery Uterine anomalies Pre-existing medical conditions Pre-eclampsia IUGR
What are risks of prematurity?
Increased mortality Respiratory distress sydnrome Intraventricular haemorrhage Necrotising enterocolitis Chronic lung disease Hypothermia Feeding problems Infection Jaundice Retinopathy of the newborn Hearing problems
How is preterm rupture of membranes managed?
Admit for 48h
Regular observations to ensure chorioamnionitis and sepsis are not developing
Oral erythromycin for 10 days
Corticosteroids for fetal lung maturity
Delivery should be considered at 34 weeks - balance risk between maternal chorioamnionitis with decreased risk of respiratory distress syndrome.
What should you do in chorioamnionitis?
IV abx including cover for group B streptococcus
Expedite labour
What are risks to fetus from PROM? Risk to mother?
Prematurity
Infection
Pulmonary hypoplasia
Limb contractures
Maternal risk:
Chorioamnionitis
What should you do in PROM if labour does not occur spontaneously?
Discharge after 48h Manage as outpatient Avoid intercourse, tampons, swimming Weekly follow up in day unit IOL after 34 weeks if cephalic
What is management of preterm labour?
Corticosteroids Tocolytics Transfer to NICU hospital Check presentation Rule out PROM Take fetal fibronectin and assess dilatation IV antibiotics to prevent GBS (benzylpenicillin) Call paediatrician
What are tocolytics? Eg.
Anti-contraction/labour suppressants
Nifedipine PO
SE: Hypotension, flushing, tachycardia,
CI: heart disease
Atosiban has fewer maternal effects
What are CI to tocolytics?
Chorioamnionitis, fetal death, lethal abnormlaity
Relative CI
Fetal growth restriction, fetal distress
Pre-eclampsia, placenta praaevia, abruption, cervix > 4cm
What is fetal fibronectin?
Protein not usually detected in vaginal secretions between 22-36 weeks
Used to rule out preterm labour and is bedside test
Positive fFN have 10% chance of preterm delivery and should be admitted and given corticosteroids
False positives if intercourse, significant bleeding, speculum, vaginal exam within 48h
What steroids are given before birth? What do these do?
Betamethasone 12 mg IM
or Dexamethasone
Help fetal surfactant production
Lower mortality and complications or RDS
Help close patent ductuses
Protect against periventricular malaria - causes cerebral palsy
Benefit occurs within 24h
Repeat doses are not beneficial - only if first course before 26 weeks
When should glucocorticoids be given?
All women at risk of iatrogenic or spontaneous preterm birth between 24 and 34+6 weeks
If growth restriction use up to 35+6 weeks
If risk at 23 weeks use only on senior advise
Use before all elective CS up to 38+6 weeks
Consider use at 35-36 weeks if delivery expedited for pre-eclampsia
What is magnesium sulphate for?
Neuroprotective effect if given antenatally for babies < 34 weeks gestation
