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Preterm Flashcards

1
Q

Classification of fetuses & neonates according to GA

A
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2
Q

Classification of fetuses & neonates according to GA

  • Preterm
A
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3
Q

Classification of fetuses & neonates according to GA

  • Term
A

GA from 37 week up to 42 weeks

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4
Q

Classification of fetuses & neonates according to GA

  • Post-term
A

GA > completed 42 weeks.

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5
Q

Classification of fetuses according to fetal weight in relation to GA

A
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6
Q

Classification of fetuses according to fetal weight in relation to GA

  • SGA
A
  • Fetal weight < 10th percentile for GA
  • Fetal weight ≥ 2 SD below mean for its GA

(SGA fetuses include IUGR or constitutionally small but healthy fetus)

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7
Q

Classification of fetuses according to fetal weight in relation to GA

  • AGA
A

Fetal weight ( ) 10th & 90th percentile for GA

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8
Q

Classification of fetuses according to fetal weight in relation to GA

  • LGA
A
  • Fetal weight > 90th percentile for GA
  • Fetal weight ≥ 2 SD above mean for its GA.
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9
Q

Classification of neonates according to birth weight

A
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10
Q

Classification of neonates according to birth weight

  • NBW
A

Neonates with birth weight > 2500 gm.

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11
Q

Classification of neonates according to birth weight

  • LBW
A
  • Neonates with birth weight ≤ 2500 gm regardless GA (LBW infants include preterm & growth retarded infants).
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12
Q

Classification of neonates according to birth weight

  • VLBW
A
  • Neonates with birth weight < 1500 gm regardless GA
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13
Q

Def of Preterm labor (premature labor)

A

Onset of labor after fetal viability & before completed

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14
Q

Def of Prematurity

A
  • Baby needs artificial aids to maintain life (needs incubation) due to deficiency of different body functions to face extrauterine life.
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15
Q

Incidence of Prematurity

A

7% of all deliveries.

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16
Q

Etiology & RF for Prematurity

A
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17
Q

Etiology & RF for Prematurity

  • Maternal Factors
A
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18
Q

Etiology & RF for Prematurity

  • fetal Factors
A

1) Fetal anomalies
2) multiple infections as TORCH
3) IUFD.

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19
Q

Etiology & RF for Prematurity

  • obstetric Compications
A

1) Polyhydramnios, PPROM
2) Chorioamnionitis
3) placenta previa, placental abruption
4) pregnancy on top of IUD.

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20
Q

Etiology & RF for Prematurity

  • Iatrogenic Factors
A

1) Premature induction of labor
2) ECV
3) amniocentesis or surgery.

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21
Q

Etiology & RF for Prematurity

  • Idiopathic
A

In 50% of cases

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22
Q

Etiology & RF for Prematurity

  • Commonest Cause
A

Idiopathic

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23
Q

Importance of Prematurity

A
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24
Q

Complications of Prematurity

A
  • Long term
  • Short term
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25
Q

Complications of Prematurity

  • Long-term
A
  • ↑↑ incidence of underdevelopment.
  • ↑↑ incidence neurological & intellectual abnormalities later in life.
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26
Q

Complications of Prematurity

  • short Term
A
  • Respiratory
  • Brain
  • Blood
  • Metabolic
  • Others
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27
Q

Short term Complications of Prematurity

  • Respiratory
A
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28
Q

Respiratory Complications of Prematurity

  • incidence
A

Asphyxia accounts for majority of neonatal deaths.

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29
Q

Respiratory Complications of Prematurity

  • Causes
A
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30
Q

Brain Complications of Prematurity

  • Incidence
A

> 10% of prematures

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31
Q

Brain Complications of Prematurity

  • Causes
A
  • Hypoprothrombinemia.
  • Immature vascular bed in germinal matrix prior to 35 weeks gestation.
  • Softness of skull allows rapid & dangerous moulding.
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32
Q

Blood Complications of Prematurity

  • Increased Bilirubin
A
  • liver is unable to conjugate bilirubin from blood sufficiently d2 enzymatic immaturity
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33
Q

Blood Complications of Prematurity

  • Anemia
A
  • Due to poor iron stores & slow synthesis of Hb molecule
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34
Q

Metabolic Complications of Prematurity

A
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35
Q

Metabolic Complications of Prematurity

  • Causes of hypothermia
A
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36
Q

Metabolic Complications of Prematurity

  • Causes of hypoglycemia
A

Due to poor glycogen stores

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37
Q

Metabolic Complications of Prematurity

  • Causes of hypocalcemia
A

Manifested by clonus, tremors or convulsions

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38
Q

Metabolic Complications of Prematurity

  • Kidney Immaturity
A

Limited ability to excrete solutes in urine

39
Q

Metabolic Complications of Prematurity

  • malnutrition
A
  • Develops easily due to poor suckling & immature
    digestive & metabolic processes.
40
Q

Metabolic Complications of Prematurity

  • Decreased Resistance to infections
A
  • Due to poor passive immunity (which is usually acquired from mother near term).
41
Q

Dx of Preterm Labor

A
  • Prediction
  • Manifestations of threatened preterm labor
  • Criteria to document preterm labor
42
Q

Dx of Preterm Labor

  • Prediction
A
43
Q

Dx of Preterm Labor

  • Manifestations
A
44
Q

Dx of Preterm Labor

  • Criteria
A
45
Q

Dx of Prematurity

A
  • Before delivery
  • After delivery (Features of prematurity at birth)
46
Q

Dx of Prematurity

  • Before Delivery
A

Tests for determination of fetal maturity

47
Q

Dx of Prematurity

  • After Delivery
A
48
Q

Prevention of Preterm Labor

A
  • General
  • Rest
  • Cervical Cerclage
  • Prophylactic tocolytic
49
Q

Prevention of Preterm Labor

  • general Measures
A
50
Q

Prevention of Preterm Labor

  • rest
A

In high risk cases as in:
- cervical incompetence, multifetal pregnancy.
- previous preterm labor, PPROM or after uterine manipulation

51
Q

Prevention of Preterm Labor

  • cervical Cerclage
A

Done when indicated as in:
- cervical incompetence, uterine anomalies
- multifetal pregnancy or previous preterm labor

52
Q

Prevention of Preterm Labor

  • tocolytics
A

Not recommended

53
Q

Managment of Preterm Labor

A
  • Bed Rest
  • Sedatives & narcotics
  • Tocolytics
  • Corticosteroides
  • managment of Delivery
  • Neonatal Care
54
Q

Managment of Preterm Labor

  • Sedatives & Narcotics
A

As barbiturates, diazepam & pethidine:
▪ these agents depress preterm infant when administrated to mother near time of delivery

55
Q

Managment of Preterm Labor

  • Bed Rest
A

Preferably in Lt lateral position to improve uterine blood flow.

56
Q

Managment of Preterm Labor

  • Tocolytics
A
57
Q

Types of Tocolytics

A
  • Short term
  • Long term
58
Q

Def of Tocolytics

A

Tocolytics are drugs that inhibit uterine contractions.

59
Q

Types of Tocolytics

  • Short term
A

Indicated to:

  • Delay labor 2-3 days till achieving max. effect of steroids.
  • Prevent preterm labor after abdominal or cervical
    operations or uterine manipulation.
60
Q

Tocolytics

  • If pregnancy is ( ) 34 & 37 weeks
A
  • Decision of tocolysis depends on quality of care available for premature infants & estimated fetal weight
60
Q

Types of Tocolytics

  • Long term
A

Not effective(oral):

  • As they stop uterine contractions temporarily but rarely prevent preterm birth
61
Q

CI of Tocolytics

A
62
Q

Tocolytics

  • In cases of PPROM with immature fetus
A
  • Some contraindicate tocolysis in all cases (for fear of chorioamnionitis) while others recommend giving short term tocolysis + prophylactic antibiotics + corticosteroids (to enhance lung maturity) then TOP.
63
Q

Tocolytics

  • Drugs Used
A
  • β-agonists
  • Magnesium sulfate (MgSO4)
  • PG synthetase inhibitors (anti-PGs)
  • Ca++ channel blockers (Nifedepine).
  • Oxytocin antagonists (atosiban)
  • Progesterone(17 α-Hydroxyprogesterone caproate)
  • Others
64
Q

B-Agonists in prematurity

  • Examples
A

Ritodrine HCL (Yutopar) or Hexoprenaline sulfate (Gynipral)

65
Q

B-Agonists in prematurity

  • Action
A

inhibition of uterine activity.

66
Q

B-Agonists in prematurity

  • Adminstration
A
67
Q

B-Agonists in prematurity

  • SE
A
  • Tachycardia, hypotension (due to VD) & arrhythmias.
  • Pulmonary edema (specially when given e steroids).
  • Hypokalemia, hyperglycemia & lactic acidosis.
68
Q

MgSO4 in prematurity

  • Action
A

Competes with Ca++ for cellular entry.

69
Q

MgSO4 in prematurity

  • Use
A

The best for diabetic patients

70
Q

MgSO4 in prematurity

  • Dose
A
  • 4-6 gm slowly IV over 15-20 minutes then 2 gm/hr by IV drips for 12-24 hours.
71
Q

MgSO4 in prematurity

  • SE
A

See preeclampsia.

72
Q

PG synthetase inhibitors (anti-PGs) in Prematurity

  • exaamples
A

Indomethacin

73
Q

PG synthetase inhibitors (anti-PGs) in Prematurity

  • Action
A
74
Q

PG synthetase inhibitors (anti-PGs) in Prematurity

  • SE
A

Maternal:
▪ Thrombocytopenia & GIT disturbances (peptic ulcers).

Fetal:
▪ Premature closure of ductus arteriosus, pulmonary HTN, necrotizing enterocolitis & ICH.

75
Q

Drugs in Prematurity

  • CCBs
A

Nifedepine

76
Q

Drugs in Prematurity

  • Oxytocin Antagonsits (Atosiban)
A

Very effective e minimal side effects.

77
Q

Drugs in Prematurity

  • Progesterone(17 α-Hydroxyprogesterone caproate)
A

Has some value in preventing onset of preterm labor but it is ineffective once labor is established (the drug of choice is)

78
Q

Drugs in Prematurity

  • Others
A

Diazoxide, ethanol & halothane (anesthetic).

79
Q

Managment of Preterm Labor

  • Corticosteroids
A
80
Q

Corticosteroids in Managment of Preterm Labor

  • Role
A

Accelerates lung maturity & ↓↓ incidence of RDS.

81
Q

Corticosteroids in Managment of Preterm Labor

  • Preparations
A

Dexamethasone or betamethasone (better).

82
Q

Corticosteroids in Managment of Preterm Labor

  • Dose
A

12 mg/ 12 hrs for 2 doses.

83
Q

Corticosteroids in Managment of Preterm Labor

  • Efficacy
A
  • Peak effect is reached after 48 hours & lasts for 1 week.
  • Best effect is when given before 30 weeks & least effect is when given after 34 weeks
84
Q

Corticosteroids in Managment of Preterm Labor

  • SE
A
  • Chorioamnionitis, early neonatal sepsis, neonatal death & delayed brain development
85
Q

Management of delivery (conduct of preterm labor)

  • Place
A
  • In well equipped hospital with availability of neonatal intensive care & neonatologist efficient in resuscitative techniques present at delivery room
86
Q

Management of delivery (conduct of preterm labor)

  • Methods
A
87
Q

Management of delivery (conduct of preterm labor)

  • Vaginal
A
88
Q

Vaginal Delivery of Preterm Labor

  • During 1st stage
A
89
Q

Vaginal Delivery of Preterm Labor

  • During 2nd Stage
A

Important precautions:
- Generous episiotomy once head reaches perineum.
- Outlet forceps is the only type of forceps allowable.
- Ventouse is contraindicated.
- No vigorous manipulations

90
Q

Vaginal Delivery of Preterm Labor

  • during 3rd stage
A

As normal labor.

91
Q

CS Delivery of Preterm Labor

A
92
Q

Neonatal Managmnet of Pretem Labor

A

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