prematurity Flashcards
define prematurity and its classification
Infants born before 37 weeks gestation – Extremely preterm <28 weeks (<1% in UK, but 51% of infant deaths) – Very preterm 28-32 weeks – Moderate to late preterm 32-36+6 weeks
antenatal risks for preterm delivery
chroioamnioitis
IUGR
maternal HTN
gestational diabetes
preterm birth neonatal risks
bone mineralisation
saccular and alveolar stages of lung development
maturation of the HPA axis
vascular tree development adn cardiomyocyte proliferation
nephrogenesis
neonatal risks of prematurity
• Neonatal death • Respiratory distress syndrome • Chronic lung disease • Intraventricular hemorrhage • Necrotizing enterocolitis • Sepsis • Retinopathy of prematurity • <28 weeks: – physical disabilities, – learning disabilities, – behavioural problems, – visual and hearing problems
sepsis lung/brain injury malnutrition oxygen toxicity mechanicla ventilation parentral nutrition steroids
most common cause of preterm birth
PPROM
what is PPROM
amnitoic sac ruptures
before 37 weeks and before the onset of labour
PPROM complications
- prematurity
- sepsis and chorioamnionitis - bacteria form lower genital tract enter uterus and sac
- cord prolpase - can come thru cervix due to gravity - OBSTETRIC EMERGENCY AS IT CAN LEAD TO FETAL HYPOXIA
- pulmonary hypoplasia - amniotic fluid helps with lungs this is a risk for respiratory distress syndrome
Clinical history of PPROM
• Gush of fluid from vagina • Leaking vaginal fluid • Increased watery discharge • Concern or uncertainty about urinary incontinence
Examination and Ix of PPROM
• No digital vaginal examination - increase risk of intrauterine infections, lead to PG release trigger preterm labour
• Sterile speculum examination:
– Pool of fluid ! Confirmed
– No fluid seen ! test (different brands):
• ActimPROM
• AmniSure
these are swab tests for sepcific markers
• FBC, CRP, HVS
US - show oligohydraminos
what is actim-prom
• IGFBP-1
– insulin-like growth factor binding protein-1
– Produced by decidual cells
– Present in amniotic fluid in high amounts
– Not normally found in vagina
• High sensitivity and specificity
– Does not interact with blood or other bodily fluids
• Can use at any gestational age
PPROM Mx
admit ppt for obs at least 24-72h
- inform NICU or SCBU
lung maturity
- dexamethasone if under 34 weeks
infection
- erythromycin for 10 days or until labour if sooner
reduced morbidity, delays deliver, allows steroid to take effect
- monitor CRP, WBC, feral HR, temp, maternal HR
expectant Mx until 37 weeks
- unless signs of pyrexia
- GBS consider after 34 weeks
what is preterm labour
Labour/regular contractions resulting in changes in
cervix before 37/40
– Threatened upto 4cm
– Established
risks for preterm labour
previous preterm delivery extremes of age ie teenagers, elderly multiple pregnancy trauma or surgery infection - bacterial vaginosis HTN diabetes drug abuse smoking previous late miscarriage asymptomatic bacteruria
which women at high risk of preterm labour
– Spontaneous preterm birth
– Mid-trimester loss (16+)
– PPROM
– Cervical trauma ie CIN
what do high risk for preterm labout women need
TV USS
HVS - bacterial vaginosis increased risk of poor pregnancy outcomes
If shortening between 16-24 weeks, can give prophylactic
vaginal progesterone or perform cervical cerclage
– Cerclage needs to be removed before labour - place a suture or ribbon around cervix to keep it closed
