Prematurity

Question 1

What is the definition of prematurity?

Answer 1

Born before 37 weeks gestation
Extremely premature: <28 weeks
Very premature: 28-32
Moderate to late premature: 32-36+6

Question 2

Is prematurity the single biggest cause of neonatal morbidity and mortality in UK?

Answer 2

Yes

Question 3

Prematurity increases the risk of the baby having…

Answer 3

RDS, chronic lung disease
IVH
NEC
Sepsis
Retinopathy of prematurity

Question 4

What percentage of those born <28 weeks will have cerebral palsy?

Answer 4

11%

Question 5

What is the most common cause of preterm birth?

Answer 5

Preterm prelabour rupture of membranes (PPROM)

Question 6

PPROM is associated with what percentage of preterm births?

Answer 6

30-40%

Question 7

What causes are there for preterm labour?

Answer 7

Multiple pregnancy
APH
Cervical incompetence 
Chorioamnionitis 
Uterine abnormalities 
DM
Polyhydramnios
Pyelonephritis or other infections 
In 40% the cause is unknown

Question 8

What risk factors are there for preterm delivery?

Answer 8

Previous preterm delivery
Extremes of age
BV
Smoking, drug abuse
Previous cervical surgery e.g LLETZ 
Previous late miscarriage 
Multiple pregnancy
Asymptomatic bacteruria 
Chronic conditions - HTN, DM
Pregnancy defined illnesses e.g pre-eclampsia

Question 9

How is preterm labour defined?

Answer 9

Regular contractions resulting in changes to cervix (effacement or dilation) before 37 weeks

Question 10

What is threatened and established preterm labour?

Answer 10

Threatened = up to 4cm dilated 
Established = after 4cm

Question 11

What percentage of preterm labour is spontaneous?

Answer 11

75% - may or may not be associated with PPROM

Rest = elective

Question 12

How can preterm labour be prevented?

Answer 12

Target high risk women for more intensive surveillance and prophylactic intervention
High risk women according to NICE = women with a history of:
Spontaneous preterm birth
Mid trimester loss
PPROM in past
Cervical trauma

TVUSS to assess cervical length and HVS for infection
If shortening occurs between 16-24 weeks can give prophylactic progesterone or cervical cerclage

Question 13

What is cervical cerclage?

Answer 13

Suture around cervix to keep it closed

Question 14

During history, what kind of symptoms may indicate preterm labour ?

Answer 14

Menstrual like cramping
Mild, irregular contractions 
Low back ache 
Pressure sensation in vagina/pelvis
Vaginal discharge of mucus - clear, pink, bloody 
Spotting, light bleeding