Preterm Labour Flashcards
What is the definition of late preterm labour?
34-37/40
What is the definition of early preterm labour?
<34/40
What is the definition of very preterm labour?
28-32/40
What is the definition of extreme preterm labour?
<28/40
What proportion of PTB is iatrogenic?
20%
What are four possible mechanisms for spontaneous PTL?
- Premature activation of maternal or fetal HPA axis
- Exaggerated inflammatory response or infection
- Decidual haemorrhage
- Pathological uterine distension
What are the risk factors for PTB (20!)
Previous PTB (15-30% recurrence, usually at same gestation) Multiple gestation IVF Uterine anomaly including fibroids Previous cervical surgery PPROM Previous 2nd trimester abortion Polyhydramnios Genital tract infection Asymptomatic bacteruria Systemic infection Maternal chronic disease APH - 1st trimester / praevia / abruption Smoking Extremes of age Anaemia IUGR Fetal anomaly (or demise) Social factors Genetic factors
+ CS at fully
At what gestation (of prematurity) should you NOT do FBS and FSE?
< 34/40
What is bronchopulmonary dysplasia?
Oxygen requirement at 28 days old or at 36/40
Multi factorial
What is apnoea of prematurity?
Central, obstructed or mixed
Desaturation and bradycardia
Immaturity of central respiratory drive
Treat with caffeine
What is periventricular leukomalacia?
What is it associated with?
Hypoxia of watershed areas of brain white matter
Associated with cerebral palsy - spasticity and neurodevelopmental delay
What are 13 complications of prematurity?
RDS Apnoea of prematurity TTN BPD NEC PDA Feeding intolerance IVH PVL Sepsis
Hypothermia
Hypoglycaemia
Jaundice
What was the finding of the Cochrane review looking at
- prenatal administration of progesterone to prevent PT in women considered to be at risk of PT
Benefits in prolonging pregnancy and in infant health
`What was the finding of the Cochrane review looking at
- combinations of tocolytic drugs for inhibiting PTL?
Unclear whether combination therapy better than single tocolytic therapy
What was the finding of the Cochrane review looking at
- Calcium channel blockers for inhibiting PTL?
Benefits over placebo with regard to - prolongation of pregnancy - serious neonatal morbidity - maternal adverse effects but NO difference in perinatal mortality
Benefits over betamimetics, ORAs and MgSO4
What was the finding of the Cochrane review looking at
- antibiotics for asymptomatic bacteruria in pregnancy?
May be effective in reducing risk of pyelonephritis in pregnancy
MAY be a reduction in PTB and LBW with antibiotics
2019
What was the finding of the Cochrane review looking at
- antibiotics for BV in pregnancy
Can eradicate BV, but overall risk of PTB was not reduced