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Obstetrics > Preterm Labour > Flashcards

Preterm Labour Flashcards

1
Q

What are tocolytics?

A

They are medication that are used to cause uterine relaxation and stop or delay preterm labour

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2
Q

What is the definition of preterm labour?

A

It is labour that occurs before 37 weeks with regular contractions, cervical changes and rupture of membranes

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3
Q

What can we say is preterm labour if we do not know the gestational age of the baby?

A

We can classify it as preterm if the baby’s weight is <2500g

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4
Q

What gestational age is considered safe to deliver at as a result of the lungs being developed?

A

34 weeks

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5
Q

What are the factors that have improved the prognosis for premature babies in NICU?

A
  1. Administration of steroids
  2. Administering Surfactant for hyaline membrane disease
  3. CPAP
  4. Kangaroo mother care
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6
Q

What are the clinical signs of chorioamnionitis?

A
  1. Pyrexia
  2. Maternal and fetal tachycardia
  3. tenderness of the uterus
  4. Draining amniotic fluid with offensive smell
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7
Q

What is sub-clinical chorioamnionitis?

A

-it is when none of the clinical signs of chorioamnionitis are present but macroscopic or histological signs of chorioamnionitis are present

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8
Q

How does infection lead to preterm labour?

A

The bacteria ascend into the cervix and affect the membranes and placenta and enter the amniotic fluid. They release prostaglandins which then initiate contractions and lead to preterm labour

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9
Q

What are the maternal factors that can lead to preterm labour?

A
  1. Cervical incompetence
  2. Uterine factors -congenital abnormalities like septate uterus and leiomyomas
  3. Pyrexia from other diseases-malaria, pyelonephritis, UTI
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10
Q

What are the fetal factors of preterm labour?

A
  1. Multiple pregnancies and polyhydroamnios (overdistension of the uterus)
  2. Congenital abnormalities like neural tube defects and gastrointestinal defects causing polyhydroamnios
  3. Syphilis (TORCH)
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11
Q

What are the placental factors for causing preterm labour?

A
  1. Abruptio placentae

2. Placenta praevia

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12
Q

Which patients are at a higher risk of preterm labour?

A
  1. Previous preterm labour
  2. No antenatal care
  3. Smoking, alcohol
  4. Poor socio-economic circumstances
  5. Sex in the second half of pregnancy
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13
Q

What are Braxton hicks contractions?

A

These are:

  • irregular
  • uncomfortable but not painful
  • not associated with cervical effacement and dilation
  • no progressive increase in duration and frequency
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14
Q

How do contractions of early or preterm labour feel like?

A
  1. Regular
  2. Painful
  3. Increase in duration and frequency
  4. Cause cervical dilation and effacement
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15
Q

What is the management if the baby is being born <24 weeks?

A

Inevitable termination of pregnancy

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16
Q

What is the management if the baby is between 24-33 weeks?

A

Then the mom and baby has to be transferred to to a regional or tertiary hospital where there are NICU facilities

17
Q

What are the tocolytics we can use to suppress labour?

A
  1. Nifedipine (adalat)
  2. Salbutamol
  3. Oxytocin receptor antagonists (atosiban)
  4. Indomethacin (prostaglandin inhibitor)
18
Q

What is the drawback of atosiban?

A

It is not used in public hospitals in south Africa

19
Q

What is the dose of Adalat (nifedipine) we give?

A

10mg three times and then increase it to 20mg 8 hourly

20
Q

When do we use salbutamol the most?

A

When we need acute suppression of labour in the case of cord prolapse or foetal distress

21
Q

What is our first choice in tocolytics?

A

Nifedipine-make sure you give the patient Nifedipine before we transport the patient from primary care to tertiary care

22
Q

How long should we try to suppress labour by in order for steroids(betamethasone) to take full effect?

A

48 hours

23
Q

What are the contra-indications for suppressing labour?

A
  1. Foetal distress
  2. Chorio-amnionitis
  3. Intra-uterine growth restriction
  4. Intra-uterine death
  5. Congenital abnormalities not compatible with life
  6. Pre-eclampsia
  7. Antepartum haemorrhage of unknown origin
  8. Pregnancy duration of >34 or <24 weeks
  9. Cervical dilation of >6cm
24
Q

When is the use of Nifedipine (Adalat) contra-indicated in patients?

A
  1. In any hypertensive situations because it can dramatically decrease the blood pressure
  2. Any condition that impairs the function of the myocardium
25
Q

What is the contra-indication for using salbutamol?

A
  1. Cardiac valvular lesions like mitral stenosis because the use of Nifedipine can lead to pulmonary oedema
  2. Diabetes mellitus because salbutamol can increase glucose
26
Q

What are the side effects of using Indomethacin in the suppression of labour?

A
  1. Gastrointestinal mucosal irritation
  2. Renal failure
  3. Early closure of PDA
  4. Fluid retention
  5. Platelet dysfunction
27
Q

What is the approach to suppressing labour in these patients?

A
  1. First line- Nifedipine(Adalat) 10 mg x3 tablets PO
  2. Second line: Salbutamol
  3. Third line: Indomethacin 100mg rectal suppository 12 hourly
28
Q

What is the dose of Nifedipine we give?

A

We start by giving 10mg three times PO

  • If there’s not contractions: give 20mg 8 hourly
  • if there’s contractions: 20mg 3 hours after then 8 hourly
29
Q

How do we mix the salbutamol?

A

We mix 250 mcg(0,5ml) in 10 ml syringe with 9,5 normal saline and give that over 5 minutes
-then 1000mcg in 200ml Normal saline and a 30ml/hour infusion is given and then increased to 60ml/hour if the contractions increased

30
Q

What are the contra-dictions to the use salbutamol?

A
  1. Heart valve disease
  2. Shocked patient
  3. Resting tachycardia
31
Q

When should we decrease the dose of salbutamol in these patients?

A

When the maternal HR is above 120

32
Q

When is the only appropriate time to give indomethacin?

A

<32 weeks

This is because after 32 weeks it can lead to intra-uterine death because the closure of the PDA

33
Q

What are the prophylactic antibiotics we need to give to the patient?

A

Ampicillin and metronidazole to treat asymptomatic chorioamniotis

34
Q

What is the dose and frequency of giving steroids?

A
  1. 12mg 24hourly IV
35
Q

How should we monitor the patient when administering salbutamol?

A
  1. ECG because the patient may experience tachycardia
36
Q

How many doses of Indomethacin are we not supposed to exceed in a 48 hour period?

A

4 doses

2 dose should be adequate

37
Q

Why do we not give steroids after 34 weeks?

A

Because the lungs have matured enough and we need to ensure that we give them between 27-34 weeks for maximum benefit

38
Q

What are the dangers associated use of steroids in these patients?

A
  1. Avoid steroids if active infection is clinically evident because it causes impaired immunity
  2. If CD4 count is <250
  3. Crepitations pointing to pulmonary oedema

Obstetrics (18 decks)

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