Preterm labour/PPROM Flashcards
What is P-PROM
Preterm prelabour rupture of membranes - before 37 weeks
What is ROM
Rupture of membranes - amniotic sac ruptured
SROM
Spontaneous rupture of membranes
Whaat is PROM
Prelabour rupture of membranes - before onset of labour
OR
Prolonged rupture of membreanes - more than 18 hours before delivery
When are babies considered non viable
Before 23 weeks
When are babies considered non viable
Before 23 weeks
When is resuscitation not considered in babies showing no signs of life
23-24 weeks
Classification of prematurity
- Under 28 weeks: extreme preterm
- 28 – 32 weeks: very preterm
- 32 – 37 weeks: moderate to late preterm
Prophylaxis of preterm labour
Vaginal progesterone
Cervical cerclage
How does vaginal progesterone stop preterm labour
Decreases activity of myometrium and prevent cervix remodelling in prep for delivery
Who is offered vaginal progesterone
Cervical length of less than 25mm on vaginal US between 16 and 24 weeks gestation
What is cervical cerclage
stitch in cervix to add support and keep it closed - spinal or generla anaesthetic
Removed when enters labour or reaches term
Who is offered cervical cerclage
<25mm on vaginal US cervical length, 16-24 weeks gestation and prev premature birth or cervical trauma eg colonoscopy and cone biopsy
When is rescue cervical cerclage offered
16 and 27+6 weeks
Cervical dilatation without ROM to prevent progression and prem delivery
Diagnosis of membrane rupture
Speculum examination - polling of amniotic fluid in the vagina
What tests are performed when doubt about ROM diagnosis
Insulin like growth factor binding protein (IGFBP-I) - tested on vaginal fluid
Placental alpha-microglobulin-I (PAMG0I) - similar alternative
Fibronectin
Managmenet of ROM
Prophylactic antibiotics - prevent development of chorioamnionitis
What antibiotics give in ROM
Erythromycin 250mg 4 times daily for 10 days or until labour initiated
What is preterm labour with intact membranes
Regular painful contraction and cervical dilatation without rupture of amniotic sac
What needs to be done to diagnose preterm labour - 30 weeks before vs after
<30 weeks - clinical assessment is enough to offer management
>30 weeks - transvaginal US - assess cervial length
What cervical length can offer management for preterm labour vs not on transvaginal US after 30 weeks
<15mm can offer
>15 mm - preterm labour unlikely
What is foetal fibronectin?
Glue between chorion and uterus
Found in vagina druing labour
What level of foetal fibronectin indicates preterm labour is unlikely
<50ng/ml - negative
How to improve outcomes of preterm labour
Foetal monitoring (CTG or intermittent auscultation)
Tocolysis with nifedipine
Maternal corticosteroids
IV magnesium sulphate
Delayed cord clamping or cord milking
What is tocolysis
Using medications to stop uterine contractions
What is the medication of choice for tocolysis
Nifedipine - CCB
What is used as an alternative for nifedipine in tocolysis
Atosiban - oxytocin receptor antagonist
When can tocolysis be used
24 and 33+6 weeks gestation
Why is tocolysis used
delay delivery and buy time for further fetal development, administration of maternal steroids or transfer to a more specialist unit (e.g. with a neonatal ICU).
Only used as a short term measure
How many weeks gestation give antenatal steroids before
36 - lungs still no deceloped
eg two doses of IM betamethasone - 34 hours
What helps protect the foetal brain during premature delivery
IV magnesium sulfate
What drug decrease the chance of cerebral palsy
IV magnesium sulphate
When is IV magnesium sulphate given
Within 24 hours of delivery of preterm babies less than 34 weeks gestation
Given as bolus, followed by infusion upt o 24 hours after birth
What do mothers need monitoring for when on IV magnesium sulfate
Magnesium toxicity at least four hourly
How monitor for magnesium toxicity
Tendon reflexes - patella reflex
Monitor obs
Sigsn:
Reduced resp rate
Reduced BP
Absent reflexes
