Prematurity Flashcards
What is prematurity defined as?
birth before 37 weeks
What are RF for prematurity?
→ Previous preterm birth → Multiple pregnancy → Cervical surgery e.g. LLETZ, cone biopsy → Uterine anomalies → Pre-existing medical conditions → Pre-eclampsia → IUGR
what are types of preterm births
- Spontaneous
2. Indicated/iatrogenic e.g. eclampsia
What is preterm rupture of membranes?
water breaking before labour starts
What is the management of preterm rupture of membranes?
admit for 48hr
rule out chorioamnionitis and sepsis
give corticosteroids
give erythromycin
What should be done if there is chorioamnionitis?
expedite delivery regardless of gestation
What are risk of PROM to the fetus
prematurity
infection
pulmonary hypoplasia
limb contractures
What is the management of preterm labour
treat case - may help cease
give CS
Give benzylpenicillin and gentamicin (GBS)
Check presentation, speculum to rule out PROM, assess dilatation if no PROM
FBC, CRP, MSU HVS
fetal fibronectin
What are tocolytics
medications used to suppress labour, and reduce contractions
What tocolytics are given in preterm labour
nifedipine
terbutaline
What are the absolute CI of tocolytics?
chorioamnionitis
fetal death
lethal abnormality
Condition needing immediate delivery
What are relative CI for tocolytics
growth restriction/distress pre-eclampsia placenta praevia abruption cervix >4cm
what is fetal fibronectin?
used to rule out preterm labour
not usually detected in vaginal secretions between 22-36 weeks
What does positive fibronectijn mean?
10% chance of preterm delivery so admit and give CS
What are glucocorticoids for?
for fetal surfactant production
reduce mortality and complications of RDS
What does giving glucocorticoids help prevent?
periventricular Malacia, a cause of cerebral palsy, by closing the PDA
What are indications of glucocorticoids
women at risk of preterm birth between 24-34+6 weeks
IUGR up to 35+6 weeks
35-36w if delivery expedited for pre-eclampsia
What are examples of glucocorticoids
prednisolone
hydrocortisone
betamethasone
When is MgSO4 given
before 34 weeks
How should the baby be managed if delivery occurs <28w
room temp of 26
wrapped in plastic wrap or bag w/o drying
place under heat whilst stabilising
3 min delay in cutting cord
hold baby 20cm below the Introitus to increase haematocrit
