Preterm labour and PPROM Flashcards
Definition (in terms of gestational age) of preterm labour
Delivery between 24-37w
At what gestational age do most foetal complications occur
Before 24w
Signs and symptoms of preterm labour
- Increased vaginal discharge
- Mild lower abdominal pain
- Bulging foetal membranes on examination
- Painful uterine contractions
Signs and symptoms of PPROM
- “Popping sensation”
- Gush or steady flow of small amounts of watery fluid
- Painless leakage of fluid from vagina (may see meconium in fluid)
- Absence of steady labour contractions
Most common causes of preterm labour
- idiopathic
- multiple pregnancy
Less common risk factors for preterm labour
- Previous preterm birth
- Previous late miscarriage
- Cervical surgery/ LLETZ
- Antepartum haemorrhage
- Uterine anomalies
- IUGR
- PPROM
- Genital tract infection
- Medical conditions eg renal disease
- Pre-eclampsia
- Antiphospholipid syndrome
On measuring cervical length to assess preterm labour, what length is likely to indicate labour
15mm or less
What concentration of foetal fibronectin is considered positive
50ng/ml or more
If foetal fibronectin is positive, when is preterm birth likely to occur
Within 7-10 days of testing
Who should get prophylaxis for preterm labour
- hx of spontaneous preterm birth/ mid-trimester loss between 16 to 34 weeks
- cervical length <25mm between 16 to 24 weeks
Types of prophylaxis for preterm labour
- vaginal progesterone
- cervical cerclage
Contraindications to cervical cerclage
- Signs of infection
- Active vaginal bleeding
- Uterine contractions
Types of tocolysis
- nifedipine
- oxytocin receptor antagonists
To what group of pregnant women MUST corticosteroids be given
Women between 26 to 33+6 weeks
Why is magnesium sulphate given to mothers going through preterm labour
for neuroprotection of baby
First sign of magnesium toxicity
Loss of patellar reflexes
Risk factors for PPROM
- Smoking
- Previous preterm delivery
- Antepartum haemorrhage
- Lower genital tract infection
Best investigation for diagnosis of PPROM
Speculum exam: look for pooling of amniotic fluids
Tests to do on vaginal fluid to support diagnosis of PPROM
- Insulin-like growth factors binding protein-1 test
* placental alpha-microglobulin-1
Management of PPROM
- prophylactic antibiotics
- look out for intrauterine infection
How to check for intrauterine infection
- CRP
- WBC
- foetal heartrate in CTG
Considerations in delivering a baby in a mother who has PPROM
- Consider delivery at 34weeks
* Over 36w: increased risk of chorioamnionitis, reduced risk of respiratory problems for baby
If a baby is term and PPROM has happened, by when should the baby be delivered
Before 96h following membrane rupture
due to infx risk
What causes chorioamnionitis
bacteria ascending uterus from vagina
