Preterm Labour Flashcards
(43 cards)
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
What was the finding of the Cochrane review looking at
- effect of umbilical cord clamping in PTB
Delayed, rather than early cord clamping may reduce the risk of death before discharge for babies born preterm
At 23/40, what are the
- survival rates
- survival without major/minor morbidity
Survival rate - 55%
Survival without morbidity = 2.3%
At 24/40, what are the
- survival rates
- survival without major/minor morbidity
Survival: 70%
Survival without morbidity: 0%
At 25/40, what are the
- survival rates
- survival without major/minor morbidity
Survival rate: 78%
Survival without morbidity: 2%
What is the mechanism by which steroids help lung development?
Accelerated development of Type 1 and 2 pneumocystis
Leading to structural and biochemical changes that improve lung mechanics and gas exchange
Increases surfactant production
Induce pulmonary beta receptors, induce antioxidants and promote lung fluid absorption after birth
Until what gestation, should you consider rescue / repeat dose steroids?
32+6/40
What is the role of steroids prior to El LSCS
Can use “if there is known fetal lung maturity” past 34+6/40 (vague)
Current recommendation in NZ is not to give unless CS <39/40
