Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBGYN 4MB > Preterm Delivery > Flashcards

Preterm Delivery Flashcards

1
Q

Define preterm delivery

A

Delivery between 24-37wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the incidence of preterm delivery?

A

5-8% deliver preterm (but a further 6% of deliveries present preterm with contractions but deliver at term)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the complications for the baby of preterm delivery

A
  1. Neurological:
    - HIE
    - Retinopathy of prematurity
    - CP
    - IVH
  2. Respiratory:
    - RDS
    - Chronic lung disease
  3. GI:
    - NEC
  4. Haematological:
    - Jaundice
    - Anaemia
  5. Infection:
    - Sepsis
    - RTI
    - UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What guideline is used in cases of preterm delivery?

A

NICE guideline NG25 Preterm Labour and Birth 2015

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the risk factors for preterm delivery

A
  1. Previous history
  2. Lower SE class
  3. Extremes of maternal age
  4. Short-inter pregnancy interval
  5. Maternal disease e.g. DM, rheumatic fever
  6. Pregnancy complications - PET, IUGR
  7. Male fetal gender
  8. STIs
  9. Vaginal infection
  10. Previous cervical surgery
  11. Multiple pregnancy
  12. Uterine abnormalities and fibroids, UTI
  13. Polyhydramnios
  14. APH
  15. Congenital fetal abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can preterm labour be prevented?

A
  1. Cervix = cervical cerclage
  2. Progesterone supplementation = suppositories from early pregnancy reduce the risk of preterm labour in those who are high risk (disputed efficacy - OPPTIMUM trial)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is cervical cerclage?

A

Cervical cerclage is the insertion of one or more sutures in the cervix to strengthen it and keep it closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the different types of cervical cerclage?

A
  1. McDonald’s cerclage - placed using permanent suture
  2. Shiradkor technique
  3. Abdominal cerclage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is cervical cerclage used?

A
  1. Elective at 12-24wks if high risk
  2. Cervix scanned regularly and only sutured if significant shortening
  3. ‘Rescue suture’
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the indications for prophylactic vaginal progesterone or prophylactic cervical cerclage?

A
  1. History of spontaneous pre-term birth or mid-trimester loss between 16+0 and 34+0 weeks of pregnancy

AND

  1. TVUS carried out between 16+0 and 24+0 weeks of pregnancy revealing a cervical length <25mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the indications for prophylactic vaginal progesterone?

A
  1. No history of spontaneous preterm birth or mid-trimester loss in whom TVU has been carried out between 16-24wks showing cervical length <25mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the indications for prophylactic cervical cerclage?

A

TVUS carried out between 16-24wks revealing cervical length <25mm and who have either of following:

  1. PPROM in previous pregnancy
  2. History of cervical trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations are carried out to determine if a woman is at risk of preterm delivery?

A
  1. Cervical length:
    - TVUS
    - Sensitive and specific
    - If cervical length <15mm at 23wks, 85% chance of delivery before 28wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List the clinical features of preterm labour

A
  1. History:
    - Painful contractions
    - Dull suprapubic ache - painless cervical dilatation
    - APH and SROM
  2. Exam:
    - Fever
    - Check lie and presentation
    - VE = dilatation and effacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What investigations should be done if preterm labour is suspected?

A
  1. Fetal wellbeing:
    - CTG
    - US
  2. Likelihood of delivery:
    - Fetal fibronectin assay (test in swab of secretions from ccervix; negative result [<50ng/ml] = delivery unlikely)
    - TVS (cervical length >15mm = delivery unlikely)
  3. Check for infection:
    - High vaginal swab (HVS)
    - Bloods - WCC, CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do we manage a woman in preterm labour?

A
  1. Fetal lung maturity:
    - Steroids at 24-37wks
  2. Fetal neuroprotection:
    - Magnesium sulphate <32wks (reduces risk of CP)
    - HSE CPG 2012 Antenatal Magnesium Sulphate for Fetal Neuroprotection
  3. Tocolysis - can delay delivery up to 7 days in some cases (NOT associated with reduction in mortality or perinatal morbidity - Greentop)
17
Q

What tocolytic agents can we use in preterm labour?

A
  1. Nifedipine - Calcium channel blocker- blocks calcium channels in the myometrium, interrupting contraction
  2. Atosiban - oxytocin receptor antagonist
18
Q

What patients benefit from tocolytic treatment?

A
  1. Very preterm labour
  2. Those who need transfer to another hospital
  3. Allow time for steroids to work
19
Q

What should be done in the presence of chorioamnionitis?

A
  1. IV abx

2. Immediate delivery

20
Q

Define preterm prelabour rupture of membranes (PPROM)

A

ROM <37wks

21
Q

What is the incidence of PPROM?

A

2% of pregnancies but accounts for 40% of preterm deliveries

22
Q

List the complications of PPROM

A
  1. Preterm delivery - follows within 48hrs in >50%
  2. Infection - fetus or placenta or cord
  3. Prolapse of umbilical cord - rare
  4. Absence of liquor - can result in pulmonary hypoplasia and postural deformities
23
Q

What is the history like in PPROM?

A

Gush of clear liquid, followed by further leaking

24
Q

What will be seen on examination in PPROM?

A
  1. Check lie and presentation
  2. Speculum - pool of fluid in posterior fornix
  3. VE - best avoided, but can be done to exclude cord prolapse if presentation is not cephalic
  4. Chorioamnionitis - characterised by contractions or abdominal pain, fever, tachycardia, uterine tenderness and coloured or offensive liquor
25
Q

What investigations should be done if PPROM is suspected?

A
  1. Confirm diagnosis:
    - Nitazine test (pH)
    - Fern test
  2. US:
    - reduced liquor volume
  3. Check for infection:
    - HVS
    - CRP
    - FBC
    - Amniocentesis with gram staining and culture
  4. Fetal wellbeing:
    - CTG
26
Q

How is PPROM managed?

A
  • Balance risk of preterm delivery vs risk of infection
  • Steroids
  • Close monitoring for signs of infection
  • If >34wks, for IOL
  • Antibiotics
27
Q

How can infection be prevented in PPROM?

A
  • Prophylactic use of erythromycin for 10days

Co-amoxiclav contraindicated, as increased neonatal risk of NEC

OBGYN 4MB (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions