Preterm Delivery Flashcards
Definition of Preterm Delivery
24 - 37 weeks
Before 24 weeks = miscarriage
Complications of Preterm Delivery
Maternal Infection Severe illness Endometritis Increased C-Section Rate
Neonatal Intensive care Cerebral palsy Death Chronic lung disease Blindness Minor diability At 24 weeks: 1/3 Die, 1/3 handicapped,
Risk Factors for Preterm Delivery
Previous Hx
Lower socioeconomic category
Extremes of maternal age
Short inter-pregnancy interval
Pre-existing maternal medical disease e.g. renal disease
PET
IUGR
Male fetal gender
High Hb
STI
BV
Uterine abnormalities and fibroids
UTI
Polyhydramnios (Multiple Pregnancy)
Congenital fetal abnormalities
Antepartum haemorrhage
Chorioamnionitis
Offensive liqour
Neonatal Sepsis
Endometritis
Investigations for Suspected Preterm Labour
Fetal State
CTG
USS
Assess likelihood of Delivery
Fetal fibronectin
TVS, cervical length >15mm long –> unaffected
Infection Vaginal swabs Sterile speculum if ROM CRP raised in chorioamnionitis WCC (raised if steroids given)
Management of Preterm Labour
Steroids and Tocolysis
Steroids
If 24 - 34 weeks
If presenting with contractions, only give if cervical length<15mm or FFN pos –> indicates significant chance of delivery
Decrease perinatal morbidity and mortality by increasing pulmonary maturity
May need tocolysis as steroids take 24 for effect
Tocolysis
Nifedipine or atosiban (oxytocin receptor antagonist)
Delay rather than stop labour –> only use for 24 hours
Ritodrine or salbutamol, and NSAIDs also delay delivery not used due to safety
Suspected chorioamnionitis –> IV antibiotics and immediate delivery
Mangnesium sulfate: neuroprotective effect on neonate if given prior to anticipated PTD
Delivery
Vaginal –> decreases rate of RDS
C-section only if indicated as for any other delivery
Breech is common in PTL –> If Term, C-section
Antibiotics given during delivery as increased risk and morbidity of Group B strep
Definition of Preterm Prelabour Rupture of Membranes
Membranes rupture before labour before 37 weeks
Complications of PPROM
PTD follows within 48 hours in 50% of cases
Chorioamnionitis or funisitis (cord infection) is common (can be before of after ROM)
Prolapse of umbilical cord
Absence of liquor (usually <24 weeks) –> pulmonary hypoplasia and postural deformities
Clinical Features and Investigations of PPROM
Gush of clear fluid followed by further leaking
Examination: pool of fluid in posterior fornix on speculum is diagnostic
Avoid digital examination, although needs to be performed to exclude cord prolapse if not cephalic
Chorioamnionitis is characterised by contractions/abdominal pain, fever, tachycardia, uterine tenderness, colored offensive liquor
Investigations
USS: Decreased liquor volume (but can be normal as fetal urine production continues)
Infection: high vaginal swab, FBC and CRP
Amniocentesis and Gm staining and culture if in doubt
Fetal well-being monitored with CTG, persistent fetal tachycardia indicative of infection
Management of PPROM
Risk of PTD balanced against risk of infection
Infection massively increases fetal mortality and long-term morbidity
Admit, give steroids
Fetal surveillance
If gestation reaches 36 weeks –> induce
Prophylactic use of erythromycin without clinical signs of infection is unusual
Avoid amoxicillin as increased risk of necrotising enterocolitis
