Preterm delivery Flashcards
What is preterm delivery?
Delivery between 24 and 37 weeks gestation.
When are the neonatal risks greater?
Before 34 weeks
How common is preterm delivery?
It occurs In 5-8% of pregnancies. A further 6% of deliveries present preterm contractions but deliver at term
What can cause preterm delivery?
It can be spontaneous labour or, usually at later gestations, can be iatrogenic (PE)
What are some acute neonatal complications of preterm delivery?
NICU, perinatal mortality, cerebral palsy
What are some long-term neonatal complications of preterm delivery?
Chronic lung disease, blindness and minor disability is common.
What are some maternal complications of preterm delivery?
Infection, particularly endometritis. C section is more commonly used.
What are some risk factors for spontaneous preterm labour?
Previous preterm delivery; lower socioeconomic class, extremes of maternal age, short inter-pregnancy interval, maternal medical disease, PE, IUGR, male fetal gender, high Hb, STIs, previous cervical surgery, multiple pregnancy, uterine abnormalities, UTI, congenital fetal abnormalities, antepartum haemorrhage
What are the mechanisms of preterm labour?
In general:
[1] too much in the uterus (twins);
[2] the foetus wants to get out (IUGR, PE, infection);
[3] the uterus can’t hold the baby (uterine abnormalities); [4] the cervix can’t hold it in anymore (cervical incompetence);
[5] infection weakens the cervix/uterus (STI, UTI)
How do you investigate predict preterm delivery?
Cervical length of transvaginal sonography (TVS) is both sensitive and specific. Prediction is not the same as prevention though, remember!
How do you prevent preterm labour?
Cervical cerclage (sutures to keep it closed); progesterone supplementation;
treatment of polyhydramnios;
treat underlying medical conditions
What is cervical cerclage and when is it performed?
The insertion of one or more sutures in the cervix to strengthen it and keep it closed. This is usually prepregnancy and can be laparoscopic.
How does progesterone supplementation take place?
Suppositories from early pregnancy reduce the risk of preterm labour in women at high risk.
What antibiotic increases the risk of preterm labour?
Metronidazole
What are the clinical features of preterm labour?
Typically, women present with painful contractions. In over half of such women, however, contractions will stop spontaneously. Antepartum haemorrhage and fluid loss are common: the latter suggests ruptured membranes