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Midwifery Emergencies > Preterm Labour > Flashcards

Preterm Labour Flashcards

1
Q

What is prematurity?

A

Birth before 37+0/40

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2
Q

What is the age of viability?

A

24/40

But >23/40 and ?400g with signs of life may be resuscitated

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3
Q

What is extreme prematurity?

A

<28/40

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4
Q

What is severe prematurity?

A

28-31+6/40

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5
Q

What is moderate prematurity?

A

32-33+6/40

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6
Q

What is late preterm?

A

34-36+6/40

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7
Q

Why should 35-36 week babies still be treated as preterm?

A

Lungs, sucking reflex and brown fat develop in the last few weeks

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8
Q

What percentage of neonatal mortality does prematurity account for?

A

70-80%

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9
Q

Give some behavioural/ environmental risk factors for preterm labour

A
  • Lifestyle
  • Nutrition
  • BMI <19.8 or >30
  • Physically demanding work
  • DV
  • Stress
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10
Q

Give some demographic risk factors for preterm labour

A
  • Low socioeconomic status
  • <17 or >35
  • Ethnic minorities
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11
Q

Give some medical risk factors for preterm labour

A
  • Infection
  • Diabetes
  • Cardiovascular/ renal disease
  • Hypertension
  • Antiphospholipid syndrome
  • Psychiatric disorders
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12
Q

Name some infections that may cause preterm labour

A
  • Chlamydia
  • Chorioamnionitis
  • GBS
  • UTI
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13
Q

How does Diabetes cause preterm labour?

A

Affects placental function due to altered insulin requirements

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14
Q

Give some reproductive risk factors for preterm labour

A
  • PPROM
  • Placental abruption/ APH
  • Inadequate AN care
  • Multiple pregnancy
  • Cervical/ uterine abnormalities
  • Polyhydramnios
  • IUGR
  • History of preterm labour
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15
Q

What are some ways in which preterm labour can be avoided?

A
  • Encourage a healthy lifestyle
  • Comprehensive AN care
  • On-going risk assessment
  • Infection screening
  • Routine MSU testing
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16
Q

What are the ways in which preterm labour is managed?

A
  • Cervical cerclage/ vaginal progesterone
  • Measurement of cervical length
  • Foetal fibronectin
  • Antenatal corticosteroids
  • Nifedipine
  • MgSO4
  • Foetal monitoring
  • Cord clamping
17
Q

According to NICE (2015), when is a cervical cerclage or progesterone used?

A
  • History of preterm birth between 16+0 and 34+0

- Cervical length <25mm

18
Q

When should a cerclage be done?

A

Only when the uterus is NOT contracting

19
Q

How do corticosteroids work?

A

Cause stress in the baby which stimulates production of surfactant that helps the lungs stay inflated

20
Q

What does Nifedipine do?

A

Inhibits contractions

21
Q

What is the purpose of giving MgSO4?

A

Neuroprotection (reduces the risk of cerebral palsy in preterm infants)

22
Q

According to NICE (2015), when should MgSO4 be offered?

A

Offer at 24-29+6

Consider at 30-33+6

23
Q

How should the cord be clamped after a preterm birth?

A

Should wait at least 30 seconds to increase blood flow and oxygen supply

24
Q

What is foetal fibronectin?

A
  • An extracellular matrix glycoprotein in the maternal-foetal interface of the amniotic membrane
  • Is present in cervical fluid up to 22/40 and then released as an indicator of possible delivery
25
Q

What are the positives and negatives of foetal fibronectin testing?

A
  • High negative predictive value but low positive predictive value
  • Inaccurate in cervix >3cm, PPROM or vaginal bleeding
26
Q

What should be done if labour continues following management?

A
  • Labour care as per NICE
  • Stop tocolysis
  • Early MDT involvement
27
Q

What should be considered for women in preterm labour?

A
  • Temperature control
  • Prevent head being on perineum for too long (episiotomy)
  • ? forceps to protect baby’s head
28
Q

What should be considered before doing a CS?

A

Has the lower segment formed? (forms 24-28/40)

29
Q

What should never be used in a preterm delivery?

A

Ventouse

30
Q

What are the 2 most common corticosteroids used?

A

Betamethasone and Dexamethasone

31
Q

Which corticosteroid is preferred and why?

A

Betamethasone

  • Greater reduction of RDS
  • Dexamethsaone = greater risk of puerperal sepsis
32
Q

What are the maternal complications of preterm birth?

A
  • Infection
  • Haemorrhage
  • Psychological trauma
  • DIC
  • Death
33
Q

What is DIC?

A

Disseminated Intravascular Coagulation (blood clots form throughout the body)

34
Q

What are the foetal complications of preterm birth?

A
  • Complications of prematurity
  • Infection
  • DEath
  • Pneumothorax
35
Q

What are some of the main complications of prematurity?

A
  • RDS
  • Poor thermoregulation
  • Glucose control
36
Q

What is a pneumothorax?

A

Collapsed lung - air leaks into space between lungs and chest wall

37
Q

What is a possible complication of a breech preterm delivery?

A

The body can come through a cervix that isn’t fully dilated and then the head can get stuck

38
Q

What is the role of the midwife?

A
  • Prevention, risk assessment and/or early detection
  • MDT involvement
  • Labour care
  • Visit to SCBU if possible
  • Assist with resuscitation
  • Keep baby warm
  • Breast milk expression
  • Emotional support

Midwifery Emergencies (5 decks)

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