preterm_labour_flashcards
What is the definition of preterm labour?
The onset of labour before 37 weeks gestation.
What is one method of preventing preterm labour?
Prophylactic Vaginal progesterone.
When should prophylactic vaginal progesterone treatment start and end?
Start treatment between 16-24 weeks gestation, and continue until at least 34 weeks gestation.
What are the indications for prophylactic vaginal progesterone?
Hx of spontaneous preterm birth (<34 weeks), mid-trimester loss (>16 weeks), and/or cervical length <25mm on TV US scan.
What is another method of preventing preterm labour?
Prophylactic cervical cerclage.
What are the indications for offering prophylactic cervical cerclage?
Hx of spontaneous preterm birth (<34 weeks) or mid-trimester loss (>16 weeks) and cervical length <25mm on TV US scan.
When should prophylactic cervical cerclage be considered?
If cervical length <25mm on TV US scan and Hx of cervical trauma or Hx of PPROM.
What is rescue cervical cerclage?
A procedure offered for cervical dilatation in the absence of uterine contractions or other signs of labour between 16-27+6 weeks gestation and unruptured membranes.
What are the contraindications for rescue cervical cerclage?
Bleeding, infection, uterine contractions.
What is the first step in the management of preterm labour?
Admit to antenatal ward.
What medication is offered to accelerate foetal lung maturation?
Maternal corticosteroids (IM betamethasone 24mg in 2 divided doses 12 hours apart).
What is the purpose of tocolytics in the management of preterm labour?
To delay delivery long enough for corticosteroid administration or transfer to a unit with neonatal facilities.
What are the contraindications for tocolytics?
Presence of bleeding or infection.
What is the first line tocolytic?
Nifedipine (calcium channel blocker).
What is the second line tocolytic?
Atosiban (oxytocin receptor antagonist).
When is IV magnesium sulphate offered?
For neuroprotection of the neonate if birth is expected within the next 24 hours.
What is the dosage of IV magnesium sulphate?
IV loading dose of 4g over 5-15 mins followed by IV infusion of 1g/hour.
How long should the IV magnesium sulphate infusion continue?
Until birth or for 24 hours, whichever is sooner.
What are the signs of magnesium sulphate toxicity?
Respiratory depression and arrhythmias.
How often should signs of magnesium sulphate toxicity be monitored?
Every 4 hours (HR, BP, RR, deep tendon reflexes).
What is the antidote for magnesium sulphate toxicity?
10ml 10% calcium gluconate over 10 mins (and stop magnesium sulphate infusion).
What is the aim for delivery timing in most cases of preterm labour?
Aim for delivery at 37 weeks in most cases.
