Preterm Labour Flashcards
definition of preterm labour
<37 weeks
Cervical changes in labour
Collagen breakdown
Change in proteoglycan conc.
Increased water
Increase in leukocyte and MP inflitration
Causes of preterm labour
Maternal: maternal infection haemorrhage infection cervical weakness Stress
Foetal:
abruption
foetal stress
RF for cervical weakness
Hx of 2nd trimester pregnancy loss
Previous cervical surgery
What complication is associated with chorioamnionitis?
Foetal brain damage (due to INF) - periventricular leukomalacia
RF for placental abruption
High BP Alcohol Smoking Coke trauma Pre-elclampsia previous abruption Thrombophilia PPROM
What test can you do to see if someone’s in PTL
Cervicovaginal foetal fibronectin
presence from 22-36wks puts you at risk of preterm labour
Mx preterm labour
Admit to antenatal ward
maternal corticosteroids
tocolytics (to delay delivery enough for steroids)
1st line - nifedipine,
2nd line - atosiban (OTR antagonist)
IV MgSO4 (neuroprotection of neonate) if delivery is expected in 24 hours
NB - can give you resp depression and arrhythmia
Aim for delivery at 37 weeks
What are some tocolytics?
CCB
OTR antagonist
b-2 agonist - ok but put you at risk of pulmonary oedema
NSAIDs - can lead to premature closure of ductus arteriosus which can put you at risk of pulmonary HTN. Also increase risk of necrotising enterocolitis and neonatal renal dysfunction
MgSO4 - reduce contractility
What antibiotics fo you give for PPROM
10 days erithromycin
Mx PPROM
Admit to antenatal ward
Prophylactic abx 10 days
maternal corticosteroids
Conservative before 34 weeks (unless signs of chorioamnionitis)
This means regular maternal bloods for infection and CTG. Also do vaginal swab but they don’t correspond well to risk of chorioamnionitis
Induce at 37 weeks
2 methods of preventing preterm delivery
Progesterone
Cervical cerclage
3 indications for cervical cerclage
History of pre term labour
If cervix is shorter than 25mm and the woman has had previous surgical procedures (US guided cerclage)
If cervix is dilating without contractions
Prevention of preterm labour
Vaginal progesterone (give between 16-24 weeks) - indications: hx of spontaneous preterm birth (<34 wks) or late miscarriage >16 wks AND/OR cervical length <25mm
Prophylactic cervical cerclage -
indications:
hx of spontaneous preterm birth (<34 wks) or late miscarriage >16 wks AND cervical length <25mm
- cervical length <25mm AND hx of cervical trauma
Rescue cerclage:
cervical dilation in absence of uterine contractions (or other signs of labour between 16-27+6)
Dx PPROM
Offer speculum If positive treat for PPROM If negative do alpha 1 microglobulin or inslulin like growth factor binding protein 1. If these are positive treat for PPROM If negative sack it off
contraindications for cervical cerclage
infection
active contractions
vaginal bleeding
When to tx preterm labour
Treatment is necessary if woman is less than or equal 29+6
What is the management if you suspect preterm labour and the mother is >30 weeks?
Do TVUSS to see if birth is possible in 48 hours (look at cervical length)
If cervix<15mm she’s in preterm labour
If cervix is equal or greater than 15mm she’s ok
If US findings are unacceptable consider foetal fibronectin (if -ve it rules PTL out)
When to give tocolytic
Consider between 24-25+6 if intact membrane and PTL
Give between 26-33+6 if intact membrane and PTL
If nifedipine contraindicate give OTR antagonist
When to give steroids
If birth is expected before 36 weeks
When to giv magnesium
Give if 24-29+6wks and they’re in PTL or expecting to deliver in 24 hours
Consider if 30-33+6 and giving birth in 24 hours
What is P-PROM
preterm premature rupture of membrane in absence of uterine activity (before 37 weeks)
what is PROM
rupture of membrane in absence of uterine activity after 37 weeks
Mx of PROM
Admit Consider Abx Monitor intensely for chorioamnionitis Expectant mx for 24 hrs if liquor is clear After this IOL
What are the stats regarding when mothers with PPROM deliver?
50% of mums with PPROM deliver within 1 week
What are the risk factors for PPROM?
previous PPROM
smokers
STI
multiple pregnancy
