Preterm Labour and PPROM part

Question 1

What gestation is classified as premature and reference?

Answer 1

Birth Before 37/40wks

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Question 2

What is classified as extreme prematurity and reference?

Answer 2

<28/40wks

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Question 3

What is classified as Severe prematurity and reference?

Answer 3

28-31/40wks

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Question 4

What is classified as moderate prematurity and refereance?

Answer 4

32-33/40wks

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Question 5

What is classified as Late preterm and refereance?

Answer 5

34-36/40wks

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Question 6

What is deemed to be the age of viability?

Answer 6

the age of viablity is 24/40wks, but if the baby is less than 23/40wks yet is estimated to be 400g and more, and is showing signs of life then resuscitation is often attempted.

Question 7

Name the 8 behavioural and environmental risk factors of prematurity?

Answer 7

Lifestyle – smoking, recreational drugs, alcohol
◦Nutrition
◦Weight (BMI <19.8 or >30)
◦Physically demanding work
◦Prolonged periods of standing and/or shift/night work
◦Domestic violence/physical abuse
◦Abdominal injury
◦Stress

Question 8

Name the three types of demographics that can determine the prediction of prematurity.

Answer 8

Low socioeconomic status
◦<17 years of age or >35 years of age
◦Ethnicity

Question 9

Name 7 medical risk factors

Answer 9

infection (accounts for up to 40% of occurrences)
◦Diabetes
◦Renal Disease
◦Cardiovascular disease
◦Hypertension
◦Antiphospholipid Syndrome ◦Psychiatric disorders

Question 10

Name the nine reproductive risk factors of preterm

Answer 10

PROM
◦Placental abruption/APH
◦Inadequate antenatal care
◦Multiple pregnancy
◦Cervical abnormalities
◦Uterine abnormalities
◦Polyhydramnios
◦IUGR
◦History of preterm labour

Question 11

Name the ways of managing preterm.

Answer 11

cervical cerclage or vaginal progesterone
◦Measurement of cervical length or fetal fibronectin
◦Antenatal corticosteroids
◦Nifidipine 
◦Magnesium Sulphate
◦Fetal Monitoring
◦Cold clamping 
◦(Antibiotics – covered in PPROM

Question 12

What would u do as a part of labour care?

Answer 12

Follow the NICE intrapartum care guideline)
◦Stop tocolysis
◦Borderline viability – early MDT involvement consulting with parents
◦Continuous CTG??
◦Spontaneous labour is often very rapid even for primigravida

Question 13

What would u do as a part of delivery?

Answer 13

Cesarean section vs vaginal(Think of ◦Gestation◦Presentation◦Fetal condition)
◦Instrumental delivery?
◦Episiotomy?
◦Avoidance of delay on the perineum
◦Active resuscitation

Question 14

What are maternal complications of preterm?

Answer 14

Infection
◦Haemorrhage
◦Psychological trauma
◦DIC (secondary to either infection or haemorrhage)
◦Maternal death

Question 15

What are fetal complications of preterm?

Answer 15

RDS, poor temperature control,
poor glucose control
◦Infection
◦Death

Question 16

Name the different things You would have to do as a midwife when in a preterm scenario

Answer 16

prevention where possible
◦Risk assessment
◦Early detection
◦Assisting medical staff and liaising with MDT
◦Labour care
◦Visit to SCBU if possible
◦Preparation for delivery (numbers of people present, likely condition of baby)
◦Assist with resuscitation
◦Keep baby warm (neo wrap, hat, radiant heaters)
◦Encourage breast milk expression
◦Emotional support for family

Question 17

Name the 6 complications of PPROM

Answer 17

Prematurity
◦Sepsis
◦Pulmonary hypoplasia
◦Cord prolapse
◦Malpresentation
◦?APH

Question 18

What is PPROM and define it

Answer 18

Preterm Pre-labour Rupture Of Membranes. This is spontaneous rupture of membranes before 37weeks and before the onset of labour.

Question 19

Name 5 of the associated factors of PPROM.

Answer 19

Preterm 
Lifestyle – smoking, recreational drugs, alcohol
◦Nutrition
◦Weight (BMI <19.8 or >30)
◦Abdominal injury
◦Stress
History of PPROM 
Multiple pregnancy

Question 20

Name the methods of management of PPROM

Answer 20

Corticosteriods – as for preterm labour
◦Antibiotics
◦Inpatient vs home care
◦Timing of delivery
◦Method of delivery

Question 21

What is amnioinfusion?

Answer 21

The process of instilling isotonic liquid in the uterine cavity