Preterm Labour Flashcards
What is preterm labour?
Labour that begins after 20 weeks gestation and before 37 weeks gestation
Risk factors of preterm labour?
- Previous history of preterm labour
- Low SES score
- Smoking/Drug use
- Cervical insufficiency
- Multiple pregnancy
- Young
Below what gestation is there an increased chance of neonatal death?
<34 weeks
Below what gestation should resuscitation not be attempted on a newborn?
<24 weeks
What are the causes of spontaneous preterm labour?
- Thrombin (recurrent PV bleeding in first and second trimester, antepartum haemorrhage)
- Cervical insufficiency (LLETZ, Cone biopsy, ERPC)
- Stretch receptors (multiple pregnancy, polyhydraminos, fibroids)
- Lifestyle factors (smoking, drug use, low ses, young, domestic violence, low maternal weight)
- Infection (chlamydia, urinary tract infection, bacterial vaginosis, periodontal disease)
Causes of preterm labour identified in pregnancy?
- Placental abruption
- Placental Previa
- Bicarbonate uterus
- Multiple pregnancy
- Cervical insufficiency
- Polyhydramnios
- Infections
- Anaemia
- Premature rupture of membranes
- Iatrogenic
- Fetal anomalies
Signs of preterm labour?
- Abdominal cramping
- Lower back pain
- Increased vaginal discharge
- Dull, lower back pain
- Suprapubic pressure
- Urinating frequently
- Diarrhoea
Tests undertaken to diagnose preterm labour
- Speculum examination
- Fetal fibronection
What is contraindicated with a speculum examination in suspected preterm labour?
- Use water only, swabs, VE, lubricant gel can interfere with fetal fibronectin results
What is fetal fibronectin test?
A test that measures fetal fribrotecin protein that is produced by the foetus that functions at the biological glue that holds the placenta to the uterine well. This test estimates how likely it is that a woman will go into labour within the next seven days.
What does a positive fetal fibronection test mean?
Fibronection >200ng/mL is a positive result which means there is an increased likelihood of the woman going into labour in the next seven days. Positive results are not very accurate, negative results are.
When is a fetal fibronectin test contraindicated?
- Sexual intercourse within 24 hours
- Rupture of membranes
- Vaginal examination within 24 hours
- Lube used within 24 hours
- Current vaginal bleeding
- Transvaginal ultrasound in last 24 hours
What is the medical management of a women in preterm labour
- Consider tocolytics
- Consider corticosteroids
- Consider magnesium sulphate
- All decided by obstetrics
What is a tocolytic?
Tocolytics are used to slow down labour in women who are <34+6 weeks gestation to allow more time for corticosteroids to be administered
A common tocolytic is nifedipine, how does this work and when are the doses given?
Nifedipine relaxes the smooth muscles and is 2 doses given 24 hours apart
What are the contraindications for nifidepine?
Hypotension and suspected uterine infection
What is the midwifery care for administration of tocolytics?
- Monitor maternal blood pressure in the first hour at the time of administration, after 30 minutes and after 60 minutes.
- Monitor maternal BP, pulse, and temperature hourly
- Ensure baseline ctg is normal prior to administration of tocolytic, keep ctg on at administration for first hour and until painful contractions cease
What a corticosteroids?
They are used to quickly develop the fetal lungs by increasing surfactant production to enable inflation of the lungs with less resistance in women that are >24 weeks to <34+6 gestation
What is the most common corticosteroid used in preterm labour, what is its dosing regime and what are its contraindications?
Betamethasome is the most common corticosteroid. 2 doses should be given 24 hours apart and is contraindicated in women with diabetes as it can affect blood sugar levels
What is magnesium sulphate used for?
Used for neuroprotection to help prevent cerebral palsy and other neurodevelopment outcomes in women >24 weeks and <30 weeks gestation in preterm labour
Signs of magnesium sulphate toxicity?
Respiratory depression, respiratory arrest, cardiac arrest and death
