Flashcards in Pre-term labour Deck (44)
What is prematurity?
Birth before 37+0
What is extreme prematurity?
What is severe prematurity?
What is moderate prematurity?
What is late pre-term?
What is the age of viability?
24 weeks, but if 23+ and 400g, showing signs of life then resus often attempted
What is the incidence?
more than 52,000 in 2012
What is the major long term concequence of prematurity?
What are the 4 types of risk factors for Preterm labour and PPROM?
1. behavioural and environmental
what are the 9 behavioural and environmental risk factors of pre term labour and PPROM?
-physically demanding work (more likely to have injury + abruption)
-prolonged periods of standing / shift work
-stress - release of catecholamines can lead to premature labour
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
What medical risk factors can cause preterm labour and PPROM? 7
Diabetes - altered insulin requirement affects placental efficiency
Hypertension (delivery is only way to reduce)
Antiphospholipid syndrome - can lead to iugr
What are the reproductive risk factors? 9
-PPROM 2% of all pregnancies- 80% will then deliver
-inadequate antenatal care- low socioeconomic status/extreme lifetstyles
-multiple pregnancy - uterus stops growing, mcmca twins delivered early to prevent twin-twin transfusion
-history of preterm labour
What are the 5 ways to prevent pre-term labour?
-encourage healthy lifestyle
-comprehensive antenatal care
-ongoing risk assessment
-routine msu testing for UTI's
How do we diagnose preterm labour?
-measurement of cervical length (<15mm high chance)
What 4 drugs are given in pre-term labour?
Antenatal corticosteroids - beta/dexamethasone
What are corticosteroids for?
26-34/40, makes baby stressed so they produce surfactant to keep lungs inflated
What is nifidipine for?
calcium channel blockers- stops the uterus contracting
What is magnesium sulfate for?
comes from pre-eclampsia as reduces maternal fits- helps baby's neurodevelopment
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
Do they do delayed cord clamping in pre-term labour?
30 seconds, no more than 3 minutes
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.
What medical options are there for tocolysis?
-atosiban (oxytocin receptor inhibitor)
-GTN (glyceryl trinitrate)
Does tocolysis improve outcomes?
there is no evidence to suggest this
Management of continuing preterm labour (5)
-borderline viability - early mdt consulting
-spontaneous labour is often very rapid even for primigravida
What 3 factors does delivery depend on?
gestation, presentation, fetal condition
What can help avoid delay on the perineum?
instrumental and episiotomy
What are maternal complications of prematurity? 5
-DIC (secondary to infection or haemorrhage)
What are the fetal complications of prematurity? 5
Poor temp control
poor glucose control