Preterm Labour - NICE Flashcards
Which patients should be offered prophylactic vaginal progesterone OR cervical cerclage?
Hx of spont birth/T2 loss between 16+0 and 34+0
and TVUS between 16-24/40 shows cx length <25mm
Which patients should be offered prophylactic vaginal progesterone only?
TVUS between 16-24/40 shows cx length <25mm with no hx prem labour
Which patients should be offered prophylactic cx cerclage only?
TVUS between 16-24/40 shows cx length <25mm and
- Previous hx of PPROM
- Hx cervical trauma
Which tests can be performed if diagnosis of PPROM is uncertain?
Insulin-like growth factor binding protein 1
Placental alpha microglobulin 1
What are the contraindications for rescue cerclage?
Signs of infection
Active bleeding
Uterine contractions
At what gestation can rescue cerclage be considered?
16+0 - 27+6
At what cervical length can a woman be treated as preterm labour if >30+0 weeks?
<15mm
When should FFN be considered and what are the cut offs for intervention?
If >30+0 weeks and TVUS indicated but not available/acceptable
<50 ng/ml - unlikely to be PTL
When should nifedipine be offered/considered for tocolysis?
Consider - 24+0-25+6, intact membranes, suspected PTL
Offer - 26+0-33+6, intact and suspected/diagnosed PTL
Oxytocin receptor antagonists if nifedipine contraindicated
When should maternal corticosteroids be offered/considered for preterm labour?
23+0-23+6 - individualised if PTL, planned early delivery or PPROM
24+0-25+6 - Consider
26+0-33+6 - Offer
34+0-35+6 - Consider
When should magnesium sulphate be offered/considered for neuroprotection?
In established preterm labour/early delivery planned:
Offer - 24+0-29+6
Consider - 30+0-33+6
What is the NNT of a singleton preterm birth with IM corticosteroids to prevent one neonatal death?
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