Preterm labour Flashcards
Define preterm, very preterm and extremely preterm labor? What is the most common?
Preterm labor < week 37.
Very preterm labor < week 32.
Extremely preterm labor < week 28.
Moderate to late preterm labor (week 32-37) is the most common.
What are the main causes of preterm labor?
Premature maternal or fetal activation of the HPA-axis.
Intrauterine infection/inflammation.
Decidual hemorrhage.
Overdistension of the uterus.
Iatorgenic labor (only non-pathophysiological cause).
What are risk factor of premature labor?
Past history: Previous preterm labor, miscarriage or TOP in the 2. trimester, and cervical insufficiency (could be because of surgery).
Antenatal factors: Multiple pregnancies, polyhydramnios, pre-eclampsia, gestational diabetes, intrauterine growth restriction, and antepartum hemorrhage.
Maternal/environmental factors: Age < 17 and > 35 years. Occupation. Stress (Psychological disorders, low socio-economical status, etc.). African american race. Smoking. Cocaine use. Anaemia. Low pre-pregnancy BMI. Congenital uterine anomalies. Uterine fibroids. Cervical and vaginal infections. Pyelonephritis.
What are the main problems in preterm infants?
Respiratory distress syndrome (RDS) Intraventricular hemorrhage (IVH). Necrotizing enterocolitis (NEC)
What is the relationship between premature delivery and risk of cerebral palsy?
Earlier delivery is associated with an increased risk of CP.
(In extremely preterm children the rate is 77 per 1 000 live births. In very preterm children the rate is 40 per 1 000.)
How many of preterm deliveries are medically indicated?
1/3.
What are symptoms/signs a woman has gone into labor?
Cramping abdominal pain.
Regular and painful uterine contractions.
Pre-labour rupture of membrane (PROM).
Cervical dilatation and effacement.
Constant low back ache.
Vaginal bleeding or “Show”.
Heaviness or pressure in the pelvic area.
In which situations is it important not to perform a digital vaginal examination?
If placenta previa is suspected, preterm pre-labor rupture of membranes (PPRM) has been diagnosed or there are no plans for immediate delivery.
What drugs can be used in the management of premature labor?
Corticosteroids – To increase fetal lung maturity.
Tocolytic Drugs – To delay delivery.
(Antibiotics – Are not recommended in preterm labor.)
MgSO4 – For neuro-protection.
True or false: Attempts to stop labor are generally not considered if the gestational age is 30 week or more.
False. Attempts to stop labor are not generally considered if the GA is 34 weeks or more.
Why is it important with continuous CTG monitoring in preterm deliveries?
Preterm infants are more vulnerable to hypoxia.
What can be complications of prematurity?
Hypothermia. Respiratory distress syndrome. Retinopathy. Patent ductus arteriousus. Bronchopulmonary dysplasia. Late onset of sepsis. Necrotizing enterocolitis. Intraventricular hemorrhage. Systemic hypotension. Hypoglycemia. Neurodevelopmental disabilites, such as cerebral palsy.
Why should we screen for preterm labor?
The disease burden - impact on families and on society.
Disappointing results from treatment of preterm labor - screening may help in instituting preventable strategies.
What current tools are there for screening of premature labor?
History Ultrasound cervical length Fetal fibronectin (fFn) Screening for bacterial vaginosis Other biochemical markers Combination of the above
What is fetal fibronectin (fFN)? What does it indicate?
Glycoprotein found in cervicovaginal secretions. Positive fFN (50 ng/mL or more) is a good predictor of delivery within 30 days. (A negative fFN is a good negative predictive value in symptomatic women.)
