Preterm Labour Flashcards
What is prematurity?
Birth before 37+0/40
What is the age of viability?
24/40
But >23/40 and ?400g with signs of life may be resuscitated
What is extreme prematurity?
<28/40
What is severe prematurity?
28-31+6/40
What is moderate prematurity?
32-33+6/40
What is late preterm?
34-36+6/40
Why should 35-36 week babies still be treated as preterm?
Lungs, sucking reflex and brown fat develop in the last few weeks
What percentage of neonatal mortality does prematurity account for?
70-80%
Give some behavioural/ environmental risk factors for preterm labour
- Lifestyle
- Nutrition
- BMI <19.8 or >30
- Physically demanding work
- DV
- Stress
Give some demographic risk factors for preterm labour
- Low socioeconomic status
- <17 or >35
- Ethnic minorities
Give some medical risk factors for preterm labour
- Infection
- Diabetes
- Cardiovascular/ renal disease
- Hypertension
- Antiphospholipid syndrome
- Psychiatric disorders
Name some infections that may cause preterm labour
- Chlamydia
- Chorioamnionitis
- GBS
- UTI
How does Diabetes cause preterm labour?
Affects placental function due to altered insulin requirements
Give some reproductive risk factors for preterm labour
- PPROM
- Placental abruption/ APH
- Inadequate AN care
- Multiple pregnancy
- Cervical/ uterine abnormalities
- Polyhydramnios
- IUGR
- History of preterm labour
What are some ways in which preterm labour can be avoided?
- Encourage a healthy lifestyle
- Comprehensive AN care
- On-going risk assessment
- Infection screening
- Routine MSU testing
What are the ways in which preterm labour is managed?
- Cervical cerclage/ vaginal progesterone
- Measurement of cervical length
- Foetal fibronectin
- Antenatal corticosteroids
- Nifedipine
- MgSO4
- Foetal monitoring
- Cord clamping
According to NICE (2015), when is a cervical cerclage or progesterone used?
- History of preterm birth between 16+0 and 34+0
- Cervical length <25mm
When should a cerclage be done?
Only when the uterus is NOT contracting
How do corticosteroids work?
Cause stress in the baby which stimulates production of surfactant that helps the lungs stay inflated
What does Nifedipine do?
Inhibits contractions
What is the purpose of giving MgSO4?
Neuroprotection (reduces the risk of cerebral palsy in preterm infants)
According to NICE (2015), when should MgSO4 be offered?
Offer at 24-29+6
Consider at 30-33+6
How should the cord be clamped after a preterm birth?
Should wait at least 30 seconds to increase blood flow and oxygen supply
What is foetal fibronectin?
- 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
What are the positives and negatives of foetal fibronectin testing?
- High negative predictive value but low positive predictive value
- Inaccurate in cervix >3cm, PPROM or vaginal bleeding
What should be done if labour continues following management?
- Labour care as per NICE
- Stop tocolysis
- Early MDT involvement
What should be considered for women in preterm labour?
- Temperature control
- Prevent head being on perineum for too long (episiotomy)
- ? forceps to protect baby’s head
What should be considered before doing a CS?
Has the lower segment formed? (forms 24-28/40)
What should never be used in a preterm delivery?
Ventouse
What are the 2 most common corticosteroids used?
Betamethasone and Dexamethasone
Which corticosteroid is preferred and why?
Betamethasone
- Greater reduction of RDS
- Dexamethsaone = greater risk of puerperal sepsis
What are the maternal complications of preterm birth?
- Infection
- Haemorrhage
- Psychological trauma
- DIC
- Death
What is DIC?
Disseminated Intravascular Coagulation (blood clots form throughout the body)
What are the foetal complications of preterm birth?
- Complications of prematurity
- Infection
- DEath
- Pneumothorax
What are some of the main complications of prematurity?
- RDS
- Poor thermoregulation
- Glucose control
What is a pneumothorax?
Collapsed lung - air leaks into space between lungs and chest wall
What is a possible complication of a breech preterm delivery?
The body can come through a cervix that isn’t fully dilated and then the head can get stuck
What is the role of the midwife?
- 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
