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Reproductive Health > Preterm labour/PPROM > Flashcards

Preterm labour/PPROM Flashcards

1
Q

What is P-PROM

A

Preterm prelabour rupture of membranes - before 37 weeks

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2
Q

What is ROM

A

Rupture of membranes - amniotic sac ruptured

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3
Q

SROM

A

Spontaneous rupture of membranes

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4
Q

Whaat is PROM

A

Prelabour rupture of membranes - before onset of labour
OR
Prolonged rupture of membreanes - more than 18 hours before delivery

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5
Q

When are babies considered non viable

A

Before 23 weeks

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5
Q

When are babies considered non viable

A

Before 23 weeks

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6
Q

When is resuscitation not considered in babies showing no signs of life

A

23-24 weeks

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7
Q

Classification of prematurity

A
  • Under 28 weeks: extreme preterm
  • 28 – 32 weeks: very preterm
  • 32 – 37 weeks: moderate to late preterm
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8
Q

Prophylaxis of preterm labour

A

Vaginal progesterone
Cervical cerclage

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9
Q

How does vaginal progesterone stop preterm labour

A

Decreases activity of myometrium and prevent cervix remodelling in prep for delivery

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10
Q

Who is offered vaginal progesterone

A

Cervical length of less than 25mm on vaginal US between 16 and 24 weeks gestation

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11
Q

What is cervical cerclage

A

stitch in cervix to add support and keep it closed - spinal or generla anaesthetic
Removed when enters labour or reaches term

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12
Q

Who is offered cervical cerclage

A

<25mm on vaginal US cervical length, 16-24 weeks gestation and prev premature birth or cervical trauma eg colonoscopy and cone biopsy

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13
Q

When is rescue cervical cerclage offered

A

16 and 27+6 weeks
Cervical dilatation without ROM to prevent progression and prem delivery

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14
Q

Diagnosis of membrane rupture

A

Speculum examination - polling of amniotic fluid in the vagina

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15
Q

What tests are performed when doubt about ROM diagnosis

A

Insulin like growth factor binding protein (IGFBP-I) - tested on vaginal fluid
Placental alpha-microglobulin-I (PAMG0I) - similar alternative
Fibronectin

16
Q

Managmenet of ROM

A

Prophylactic antibiotics - prevent development of chorioamnionitis

17
Q

What antibiotics give in ROM

A

Erythromycin 250mg 4 times daily for 10 days or until labour initiated

18
Q

What is preterm labour with intact membranes

A

Regular painful contraction and cervical dilatation without rupture of amniotic sac

19
Q

What needs to be done to diagnose preterm labour - 30 weeks before vs after

A

<30 weeks - clinical assessment is enough to offer management
>30 weeks - transvaginal US - assess cervial length

20
Q

What cervical length can offer management for preterm labour vs not on transvaginal US after 30 weeks

A

<15mm can offer
>15 mm - preterm labour unlikely

21
Q

What is foetal fibronectin?

A

Glue between chorion and uterus
Found in vagina druing labour

22
Q

What level of foetal fibronectin indicates preterm labour is unlikely

A

<50ng/ml - negative

23
Q

How to improve outcomes of preterm labour

A

Foetal monitoring (CTG or intermittent auscultation)
Tocolysis with nifedipine
Maternal corticosteroids
IV magnesium sulphate
Delayed cord clamping or cord milking

24
Q

What is tocolysis

A

Using medications to stop uterine contractions

25
Q

What is the medication of choice for tocolysis

A

Nifedipine - CCB

26
Q

What is used as an alternative for nifedipine in tocolysis

A

Atosiban - oxytocin receptor antagonist

27
Q

When can tocolysis be used

A

24 and 33+6 weeks gestation

28
Q

Why is tocolysis used

A

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

29
Q

How many weeks gestation give antenatal steroids before

A

36 - lungs still no deceloped
eg two doses of IM betamethasone - 34 hours

30
Q

What helps protect the foetal brain during premature delivery

A

IV magnesium sulfate

31
Q

What drug decrease the chance of cerebral palsy

A

IV magnesium sulphate

32
Q

When is IV magnesium sulphate given

A

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

33
Q

What do mothers need monitoring for when on IV magnesium sulfate

A

Magnesium toxicity at least four hourly

34
Q

How monitor for magnesium toxicity

A

Tendon reflexes - patella reflex
Monitor obs
Sigsn:
Reduced resp rate
Reduced BP
Absent reflexes

Reproductive Health (69 decks)

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