Preterm Labour Flashcards

1
Q

What is preterm labour

A

Onset of labour prior to 37 week gestation

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2
Q

What are sub classification of pre term Labou?

A

Very preterm <32

Extremely preterm <28

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3
Q

What is PTL correlated to?

A

Higher morbidity and mortality

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4
Q

What are common short term issues in pre term babies

A
  • Respiratory distress syndrome
  • Intraventricular haemorrhage > neurological deficit
  • Paraventricular leukomalacia
  • Necrotising enterocolitis
  • Sepsis
  • Retinopathy
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5
Q

What are key RF for preterm birth?

A

Prior preterm birth
Prior second trimester loss
Prior cervical biopsy / intervention

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6
Q

Why is second trimester loss important in PTL and not first trimester loss?

A

Because first trimester loss is likely due to genetic / chromosomal foetal abnormalities

Second trimester instead is more likely that the foetus is normal and the cervix is unable to hold it in

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7
Q

What are secondary RF for PTL?

A
  • Immunological e.g. infection, vaginal microbiome
  • Mechanical e.g. fibroids, multiple pregnancy (push down on baby)
  • Structural (uterine abnormality)
  • Social (smoking, drugs, age, BMI extremes)
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8
Q

What are common infections linked to PTL?

A

BV
UTI
Chlamydia / gonorrhoea

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9
Q

Why do UTIs commonly occur in pregnancy?

A

Due to relaxation of SM

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10
Q

What are examples of cervical interventio ns that trigger cervical weakness?

A
LLETZ 
Cone biopsy (NOT punch biopsy, as that is too small)
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11
Q

What does PTL present with?

A

Regular uterine contractions
Leaking amniotic fluid
PV bleed
Worsening lower back pain

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12
Q

What is very important to test during suspected PTL?

A

Take cervicovaginal fluid level of FOETAL FIBRONECTIN

fFN

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13
Q

What is fFN?

A

A glycoprotein produced by chorionic membranes as you are approaching labour

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14
Q

What are boundaries of ffN and what does it indicate?

A

fFN <50 gives a NEGATIVE result, so chance of delivering in next week is <1%

fFN >50 is POSITIVE RESULT (so admit, potential tocolysis etc.)

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15
Q

What are tocolytics?

A

Medications that delay labour for long enough to give corticosteroids and magnesium sulphate

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16
Q

What Is the common tocolytic given?

A

Nifedipine (calcium channel blocker)

Inhibits calcium influx into cells > prevents SM contraction

17
Q

Why must you not give beta agonists as tocolytics

A

Because they have important maternal side effects e.g. pulmonary oedema

18
Q

Why must you not give NSAIDS as tocolytics?

A

NSAIDS inhibit prostaglandins

this causes::

  • premature closure of ductus arteriosus
  • leads to persistent pulmonary hypertension
19
Q

When are corticosteroidfs given in PTL?

A

24-34 week gestation

20
Q

How many doses of corticosteroids must be given?

A

2 doses 24h apat

21
Q

How long does corticosteroid benefit last fo?

A

2 to 7 days

22
Q

What are corticosteroids to give in PTL

A

‘Dexamethasone

23
Q

What do you need to keep in mind if giving steroids in PTL mother?

A

That steroids increase WCC

This means there is an increased risk of confusion if the mother is infection

24
Q

What is a negative effect of giving repeated doses of steroids on the foetus?

A

Impact baby IQ

25
What other dug would you consider in PTL with PPROM?
Antibiotics | 10 day course of erythromycin
26
How do you predict risk of preterm delivery?
Based on Past Obstetric Hx (prior PTD) | Based on cervical length measured on TVUSS (short cervix > high risk)
27
When would you perform a rescue cerclage?
At 16-24 weeks, if cervix is dilated (with exposed membranes) but membranes are intact and there are no contractions
28
Why myst you not consider rescue cerclage is membranes are ruptured?
Because infection had spread to abdomen | There is likely chorioamnionitis developing
29
When would you do an US indicated cerclage?
When cervix shortens <25 mm in women with history of cervical surgery / prior PTD
30
What is PPROM?
Ruptured membranes <37 weeks with not uterine contractions
31
How is delivery related to PPROM?
Most deliveries occur in next 24h
32
What is PPROM diagnosed qwith?
Clinical history | Pool of liquor in vagina on speculum
33
How do you treat PPROM?
Erythomycin 10 days | Expectant management unless evidence of chorioamniositis
34
What is chorioamniositis
infection of foetal membranes, usually coming from vaginal canal
35
What are symptoms / signs of chorioamniositis
``` Offensive liquor Yellow / green liquor Maternal tachycardia Temp >37.5 High CRP >40 Tender uterus, increased uterine activity CTG shows high foetal HR ```
36
What is the function of magnesium sulphate ?
Neuroprotector | Reduces risk of cerebral palsy
37
when do you perform foetal fibronectin
if suspecting preterm labour | and TVUSS is not available/not approprite
38
What. are important considerations for delivery method in PTB
C section is harder in preterm birth - increased ilkelyhood of vertical incition