Preterm delivery Flashcards
What is the definition of a preterm delivery?
Delivery between 24-37 weeks gestation.
What are the fetal complications of pre-term delivery?
Mortality.
CP.
Chronic lung disease.
Blindness.
Minor disability.
At 24 wks, 1/3 will be handicapped, 1/3 will die. By 32, this is down to 5%.
What are the risk factors for preterm labour?
Too much in the uterus: multiple pregnancies, polyhydramnios.
Dangerous to stay in the uterus: Pre-eclampsia, IUGR, infection, abruption.
Uterus is wonky: fibroids.
Cervix is weak: often after surgery to the cervix.
Infection: many agents cause preterm delivery!
What is a good predictor of preterm delivery?
Cervical length on TVUSS.
Fetal fibronectin.
How can you try and prevent preterm labour?
Cervical cerclage: suture in the cervix to keep it closed, often done prophylactically at 12-14wks.
Progesterone supplementation: progesterone suppositories from early pregnancy helps.
Fetal reduction for higher order multiples.
Amnioreduction / NSAIDs to reduce fetal urine output.
How do you manage preterm labour?
Steroids (dexamethasone / betamethason) between 24-34wks.
Tocolysis (with nifedipine / atosiban) to delay labour and give steroid time to act.
Mag. sulphate: neuroprotective.
Delivery.
Abx to cover GBS.
How does PROM present?
Gush of clear fluid, followed by leaking.
O/E: pool of clear fluid in posterior fornix on speculum is diagnostic.
If not cephalic, need to do digital exam to exclude cord prolapse.
How does chorioamnionitis present?
Contractions.
Abdo pain.
Fever.
Tachycardia.
Uterine tenderness.
Coloured / offensive liquor.
How would you manage a PROM?
Admit.
Give steroids.
Prophylactic erythromycin.
Close surveillance for signs of infection.
Induce at 36wks.
If signs of infection - IV Abx and induction.
