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Obestetrics > Preterm Labour and PPROM > Flashcards

Preterm Labour and PPROM Flashcards

1
Q

What are women at risk of preterm labour/late loss offered?

A

Prophylactic vaginal progesterone or cervical cerclage

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2
Q

Who are at risk of preterm/late loss choice of Mx

A

Hx spontaneous preterm birth/midT3 loss (16-34wk)
AND
TVUSS (wk16-24) cervical length <25mm

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3
Q

Prophylactic vaginal progesterone for risk of preterm labour/late loss

A

NO Hx spontaneous preterm birth

TVUSS wk16-24 cervical length <25

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4
Q

Prophylactic cervical cerclage for risk of preterm labour/late loss

A

TVUSS wk16-24 Cervical length <25mm
AND have either:
Hx PPROM
Hx cervical trauma

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5
Q

Diagnosing PPROM

A

Women with suggestive sx Offer sterile speculum examination looking for pooling amniotic fluid

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6
Q

If pooling amniotic fluid

A

NO diagonstic tests

Treat

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7
Q

If no pooling amniotic fluid

A

Order insulin like growth factor binding protein 1 or alpha microglobulin-1 test of vaginal fluid

  • Positive: likely PPROM if Sx
  • Neg: unlikely, no ABx
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8
Q

If labour becomes established in ?PPROM

A

Don’t do tests

Manage labour

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9
Q

Antibiotc proph. in PPROM

A

Erythromycin PO 250mg QDS
Max 10d or until established labour
2nd line: oral penicilin

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10
Q

Identifying infection in PPROM

A

Clinical assessment
CRP
WCC
CTG

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11
Q

Rescue cervical cerclage CI

A

Signs of infection
acute PV bleed
Uterine contractions

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12
Q

When to consider rescue cervical cerclage

A

16-27wk
dilated cervix
exposed unruptured membrane

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13
Q

Greatest benefits of rescue cerclage?

A

Earlier gestation

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14
Q

Risks of rescue cervical cerclage

A

ROM
Infection
Bleeding
Premature contractions

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15
Q

Aims of rescue cerclage

A

aims to delay birth and redeuce neonatal morbidity

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16
Q

Diagnosing preterm labour with intact membranes

A

Asessment: Hx, obs, speculum, cervical dilatation

17
Q

<29+6 and clinical assessment suggests preterm labour

A

treatment necessary

18
Q

If >30wk and assessment suggests preterm labour scan option

A

Consider TVUSS measurement of cervical length (likelihood of delivery in 48hrs)
if >15mm unlikely preterm
<15mm likely preterm and treat
If TVUSS unavailable/unacceptable use foetal fibronectin
- <50ng/ml unlikely preterm
->50 ng/ml likely preterm, treat

19
Q

Tocolysis factors to consider

A
  1. suspected/diagnosed preterm labour?
  2. Other clinical features that suggest stopping labour is CI (bleeding)
  3. Gestational age
  4. Likely benefit of maternal CS
  5. Availability of neonatal care
  6. Maternal preference
20
Q

Tocolysis - when to offer nifedipine

A

Consider: 24-25+6wk and intact membranes and sus/diagnosed PTL
Offer: 26-33+6: intact and in sus/diagnosed PTL

21
Q

2nd line to nifedipine in tocolysis

A

oxytocin R antagonists
Atosiban
NOT beta-mimetics

22
Q

Maternal cortical steroids in PTL - discuss with

A

23-23+6wks
PTL (suspected/established)
Having planned preterm birth
PPROM

23
Q

Benefits of maternal CS

A

reduce morbidity and mortality

reduce late miscarriage and baby death

24
Q

MgSO4 in PTL?

A

neuroprotection given IV
4g bolus/15min
IV infusion of 1g/hour until birth or 24hrs

25
Q

When to offer MgSO4 in PTL

A

24-34wk:
established PTL
OR
having planned PT birth within 24hrs

26
Q

Monitoring with MgSO4

A

Signs of Mg tox. (pulse, BP, RR, deep tendon reflexes)

every 4hr

27
Q

Foetal monitoring in PTL

A

CTG useful
?foteal scalp electrode
?foetal blood sampling

28
Q

Mode of birth on PTL

A

Offer 24 expectant Mx to commence labour (consider IOL after this)
Discuss C-section vs vaginal
Aim for delivery by 34wk
Consider C-sec if breech and pretern

29
Q

Difficulties of PTL c-section

A

More difficult to perform
higher chance vertical incision
No known benefits/harms of c-section/vaginal but limited evidence

30
Q

Summary of PTL/PPROM

A

Admit for obs (chorioamonitis)
PO erythromycin 10d
Antenatal CS
34wk delivery im

31
Q

PACES counselling of PPROM

A 
RF: smoking, STI, Hx, mulitple preg
ADMIT
Risks: infection
Risk of prematurity (want to keep inside as long as poss)
Importance of obs (maternal and CTG)
Antenatal CS
Discuss delivery

Obestetrics (21 decks)

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