Preterm Labour Flashcards
What are the risk factors for preterm labour?
- Multiple pregnancy
- Smoking
- Infection
- Uterine abnormalities
- Cervical incompetence (eg due to cancer)
- UTI
- Polyhydramnios
What is the impact of preterm labour on the baby?
They are usually severely handicapped, particularly if before 34 weeks, with risks of cerebral palsy, lung disease etc.
How can cervical incompetence be fixed?
- Cervical cerclage - stitching the cervix to make it stronger
- Progesterone supplementation
How can infection be fixed?
Early screening for infections and then appropriate antibiotics
When is foetal reduction offered?
10-14 weeks
What is the foetal fibronectin test?
This is a protein produced by the foetus that leaks into the vagina if a preterm delivery is likely to occur.
If the result is negative, the woman is unlikely to go into labour within the next 10 days. If it is positive, the result is inconclusive
How can preterm labour be managed?
- Steroids to promote lung maturity (24-34 weeks)
- Tocolytics such as nifedipine or atosiban are oxytocin antagonists
- Magnesium Sulphate (neuroprotective effect)
Name some tocolytics
Nifedipine, atosiban
How long should tocolytics be used for?
No more than 24 hours
What is PPROM?
Premature prelabour rupture of membranes - this is ROM before 37 weeks gestation
What are the risk factors for PPROM?
Smoking, vaginal bleeding, previous preterm delivery
How can PPROM be diagnosed
- Pooling of amniotic fluid
- Pad checks
- Insulin-like growth factor
What is the treatment for PPROM?
PPROM has an associated risk of infection:
- give erythromycin for 10 days, or until labour starts
- give steroids to promote lung maturation
What are the 3 main complications of PPROM?
- Prematurity (preterm labour)
- Sepsis
- Pulmonary hypoplasia
