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Flashcards in Pre-term labour Deck (44)
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1

What is prematurity?

Birth before 37+0

2

What is extreme prematurity?

<28 weeks

3

What is severe prematurity?

28-31+6

4

What is moderate prematurity?

32-33+6

5

What is late pre-term?

34-36+6

6

What is the age of viability?

24 weeks, but if 23+ and 400g, showing signs of life then resus often attempted

7

What is the incidence?

more than 52,000 in 2012

8

What is the major long term concequence of prematurity?

neurodevelopmental delay

9

What are the 4 types of risk factors for Preterm labour and PPROM?

1. behavioural and environmental
2. demographic
3. Medical
4. Reproductive

10

what are the 9 behavioural and environmental risk factors of pre term labour and PPROM?

-smoking
-drugs
-nutrition
-bmi
-physically demanding work (more likely to have injury + abruption)
-prolonged periods of standing / shift work
-domestic violence/abuse
-abdo injury
-stress - release of catecholamines can lead to premature labour

11

What demographic are more likely to go into preterm labour and PPROM? 4

-low socioeconomic status
- <17 y/o or >35 y/o
-ethnicity- from underdeveloped countries

12

What medical risk factors can cause preterm labour and PPROM? 7

Infection (Uti's)
Diabetes - altered insulin requirement affects placental efficiency
Renal disease
Cardiovascular disease
Hypertension (delivery is only way to reduce)
Antiphospholipid syndrome - can lead to iugr
Psychiatric disorders

13

What are the reproductive risk factors? 9

-PPROM 2% of all pregnancies- 80% will then deliver
-placental abruption/pph
-inadequate antenatal care- low socioeconomic status/extreme lifetstyles
-multiple pregnancy - uterus stops growing, mcmca twins delivered early to prevent twin-twin transfusion
-cx abnormalities
-uterine abnormalities
-polyhydramnios
-IUGR
-history of preterm labour

14

What are the 5 ways to prevent pre-term labour?

-encourage healthy lifestyle
-comprehensive antenatal care
-ongoing risk assessment
-infection screening
-routine msu testing for UTI's

15

How do we diagnose preterm labour?

-measurement of cervical length (<15mm high chance)
-fetal fibronectin

16

What 4 drugs are given in pre-term labour?

Antenatal corticosteroids - beta/dexamethasone
Nifidipine
Magnesium sulfate
Antibiotics

17

What are corticosteroids for?

26-34/40, makes baby stressed so they produce surfactant to keep lungs inflated

18

What is nifidipine for?

calcium channel blockers- stops the uterus contracting

19

What is magnesium sulfate for?

comes from pre-eclampsia as reduces maternal fits- helps baby's neurodevelopment

20

How do they monitor the fetus in pre-term labour?

intermittent monitoring because if CTG at 25/40 and abnormal- not going to go to emcs

21

Do they do delayed cord clamping in pre-term labour?

30 seconds, no more than 3 minutes

22

What is fetal fibronectin?

Extracellular matric glycoprotein localized at the maternal-fetal interface of the amniotic membrane- between chorion and decidua. If present in cx fluid up to 22/40 then released as indicator of possible delivery.

23

What medical options are there for tocolysis?

-atosiban (oxytocin receptor inhibitor)
-ritodrine (betamimetic)
-GTN (glyceryl trinitrate)
-indomethacin
-mag sulf
-nifidipine

24

Does tocolysis improve outcomes?

there is no evidence to suggest this

25

Management of continuing preterm labour (5)

-labour care
-stop tocolysis
-borderline viability - early mdt consulting
-continuous ctg
-spontaneous labour is often very rapid even for primigravida

26

What 3 factors does delivery depend on?

gestation, presentation, fetal condition

27

What can help avoid delay on the perineum?

instrumental and episiotomy

28

What are maternal complications of prematurity? 5

-infection
-haemorrhage
-psychological trauma
-DIC (secondary to infection or haemorrhage)
-maternal death

29

What are the fetal complications of prematurity? 5

RDS
Poor temp control
poor glucose control
infection
death

30

What is the role of the midwife?

-prevention where possible
-risk assessment
-early detection
-assisting and liasing with mdt
-labour care
-visit scbu
-prep parents for delivery
-assist with resus
-keep baby warm
-keep baby warm (neo wrap, hat, radiant heaters)
-encourage breast milk expression
-emotional support