W11_02 Preterm labour and PPROM Flashcards
define “term pregnancy”
between 37 and 40 weeks
define preterm pregnancy
before 37 weeks
note preterm births account for 75% of perinatal mortality
ok
what are the three main causes of preterm labour?
spontaneous;
PPROM;
indicated preterm birth
what are three parts of the labour process?
progesterone withdrawal;
oxytocin initiation;
decidual activation (inflammation?)
how long before labour does cervical effacement start
4-8 weeks pre-labour
most risk factors are ASSOCIATED with preterm labour, but are NOT CAUSATIVE
ok
what’s the biggest risk factor for preterm labour?
previous preterm birth
what lifestyle factors contribute to preterm labour?
smoking, low BMI, high BMI, substance use, stress
what demographic factors contribute to preterm labour?
age, race/ethnicity, SES, education (all maternal factors)
note: women who have bacterial vaginitis have less preterm labour if the infection is treated
ok
note: multiple pregnancies can increase risk of preterm labour
ok
note: bleeding is associated with increased risk of preterm labour
ok
which cervical and uterine issues increase risk for preterm labour?
previous spontaneous preterm birth;
uterine anomaly;
cervical insufficiency;
pervious cervical procedure (LEEP, cone)
note: short inter-pregnancy interval is associated with increased risk of preterm labour
ok
note: anemia and thrombophilia are two risk factors for preterm labour
ok
how to diagnose preterm labour?
regular contractions that lead to cervical dilation
what’s fetal fibronectin?
shouldn’t be present in vaginal secretions before 35 weeks; has a high negative predictive value of preterm labour
what’s tocolysis?
medical therapy to try and slow down labour
what are contraindications to tocolysis? (“need to know”)
maternal medical conditions;
chorioamnionitis;
bleeding previa/abruption;
intrauterine growth restriction;
contraindications to specific agents;
mature fetus;
intrauterine fetal demise;
imminent delivery
what’re nifedipine, indomethacin?
tocolysis agents
what’s magnesium sulphate?
slows contractions, but not indicated for tocolysis
note: mag sulphate, antocin/atosiban/tractocil, ritodrine/terbutaline are NOT indicated for tocolysis
ok
what infection to screen for in a woman with preterm labour?
GBS. If positive, treat. If not, don’t treat. Prevent GBS sepsis in neonate
