prematurity Flashcards
What is the definition of premature?
A baby born before 37 weeks
What is a low birht weight?
less than 2500g
What are the complications of prematurity?
Causes delayed development, visual impairment, chronic lung disease and cerebral palsy
What are the risk factors for prematurity?
Multiple pregnancies GUM infection previous history cervical weakness smoking drug use, amnionitis, PROM (when water breaks before onset of labour), pre-eclampsia, APH Bacterial vaginosis has a strong link
How do we treat bacterial vaginosis in pregnant women?
Bacterial vaginosis is treated with metronidazole
What are the investigations for prematurity?
always Cervical exam- over 3cm dilated indicates labour
If 30 weeks pregnant +
1st line: Transvaginal u/s to look at cervical length- if less than 15mm indicates labour
2nd line: Fibronectin test (fibronectin rises closer to labour, but can have false positives from sex, lube, bleed)
What is the management of prematurity?
before: Address risk factors and give Progesterone to prolong pregnancy as IM or pessary
1st line: Tocolysis prevents uterus from contracting –nifedipine + Corticosteroids (beta/dexamethasone)
2nd line: Oxytocin R antagonist atosiban is also used in prematurity + steroids
Consider transfer to hospital with NIUCU, check baby position
IV Mg sulfate
What may mandate baby delivery?
Pyelonephritis, pneumonia, asthma, peritonitis, trauma, and hypertension, or obstetric conditions including preeclampsia, placental abruption, placenta previa, and chorioamnionitis may mandate delivery.
What are the complications of PROM?
poorer neonate prognosis as leads to pulmonary hypoplasia
Can also lead to charioamniotis (infection may lead to spesis)
How do you manage PROM?
monitor fetus and aim to deliver bwtween 34 and 36 weeks
give prophylatic abx (erithromycin) and corticosteroids
Why are corticosteroids administered to mother if suspected premature delivery?
They develop fetal lungs by increasing surfacant via type 2 pneumocytes
When should prophylactic progesterone be offered to pregnant women?
BOTH
a history of spontaneous preterm birth (up to 34+0 weeks of pregnancy) or mid-trimester loss (from 16+0 weeks of pregnancy onwards) and
results from a transvaginal ultrasound scan carried out between 16+0 and 24+0 weeks of pregnancy that show a cervical length of 25 mm or less.
ix for PROM?
speculum exam
if pooling of amniotic fluid is not observed, perform an insulin-like growth factor binding protein‑1 test or placental alpha-microglobulin‑1 test of vaginal fluid
discuss chorioamniotitis
You should think chorioamnionitis in women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia
