Preterm Labour and PPROM part Flashcards

1
Q

What gestation is classified as premature and reference?

A

Birth Before 37/40wks

BMJ Best Practice, 2015

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2
Q

What is classified as extreme prematurity and reference?

A

<28/40wks

BMJ Best Practice, 2015

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3
Q

What is classified as Severe prematurity and reference?

A

28-31/40wks

BMJ Best Practice, 2015

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4
Q

What is classified as moderate prematurity and refereance?

A

32-33/40wks

BMJ Best Practice, 2015

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5
Q

What is classified as Late preterm and refereance?

A

34-36/40wks

BMJ Best Practice, 2015

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6
Q

What is deemed to be the age of viability?

A

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.

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7
Q

Name the 8 behavioural and environmental risk factors of prematurity?

A
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
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8
Q

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

A

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

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9
Q

Name 7 medical risk factors

A

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

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10
Q

Name the nine reproductive risk factors of preterm

A
PROM
◦Placental abruption/APH
◦Inadequate antenatal care
◦Multiple pregnancy
◦Cervical abnormalities
◦Uterine abnormalities
◦Polyhydramnios
◦IUGR
◦History of preterm labour
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11
Q

Name the ways of managing preterm.

A
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
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12
Q

What would u do as a part of labour care?

A

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

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13
Q

What would u do as a part of delivery?

A
Cesarean section vs vaginal(Think of ◦Gestation◦Presentation◦Fetal condition)
◦Instrumental delivery?
◦Episiotomy?
◦Avoidance of delay on the perineum
◦Active resuscitation
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14
Q

What are maternal complications of preterm?

A
Infection
◦Haemorrhage
◦Psychological trauma
◦DIC (secondary to either infection or haemorrhage)
◦Maternal death
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15
Q

What are fetal complications of preterm?

A

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

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16
Q

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

A

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

17
Q

Name the 6 complications of PPROM

A
Prematurity
◦Sepsis
◦Pulmonary hypoplasia
◦Cord prolapse
◦Malpresentation
◦?APH
18
Q

What is PPROM and define it

A

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

19
Q

Name 5 of the associated factors of PPROM.

A
Preterm 
Lifestyle – smoking, recreational drugs, alcohol
◦Nutrition
◦Weight (BMI <19.8 or >30)
◦Abdominal injury
◦Stress
History of PPROM 
Multiple pregnancy
20
Q

Name the methods of management of PPROM

A
Corticosteriods – as for preterm labour
◦Antibiotics
◦Inpatient vs home care
◦Timing of delivery
◦Method of delivery
21
Q

What is amnioinfusion?

A

The process of instilling isotonic liquid in the uterine cavity