Preterm Labour and Preterm Premature Rupture of Membranes Flashcards
Hx taking
- Describe abdominal pain (SOCRATES)
- Any PV bleeding?
- Any liquid?
- Any issues with urination?
- Any fever?
- Any foetal movement?
- G?P? Gestation?
- Antenatal bloods, Down’s syndrome, morphology scan, OGTT
- PMH
- SH (NSND, drug abuse, marriage status)
- Any long-term medication
Physical examination: General examination
Physical examination: Abdominal examination
Physical examination: Speculum exam
Endocervical + HVS
What blood Ix should be ordered?
What swabs should be ordered?
What should be looked at on ultrasound?
What should be observed on cardiotocography?
What is the risk of preterm labor and PROM?
Risk to foetus:
- RDS
- NEC
- IVH
- Eye problems
- Infection
Must stay in PICU
- 2x steroid injection = promote lung maturation + prevent damage to other organs
- Antibiotics = reduce risk of infection
Must monitor whether mother still has fever and baby’s heart rate
If liqor is meconisum or blood stained, must inform doctor
Give tocolytics to buy time for steroid to work (24 hours)
Management - monitoring of mother with PROM
What regimen will be given to promote foetal lung maturation?
When is the maximal neonatal benefit of corticosteroids achieved? What is the association between maternal and neonatal sepsis in PPROM? Why must corticosteroids be used with caution in combination with tocolytics?
How should antibiotics be given for women with PROM? If genital swab is +ve / -ve for GBS, what should be given? If allergic to penicillin, what should be given?
Antibiotics use in preterm premature rupture of membranes
Considerations when using tocolysis
- Expectant management can be considered in PPROM if no evidence of infection or regular uterine contractions
- Decision regarding tocolysis should be taken by senior staff (should only be considered if no evidence of infection)
- Aim to delay delivery for at least 48 hours to enable effect of steroid to enhance fetal pulmonary maturation