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O&G: Obstetrics > Delivery Before Term > Flashcards

Delivery Before Term Flashcards

1
Q

What is the definition of delivery before term?

A

Delivery at 24-37 weeks gestation, either spontaneous or iatrogenic.

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2
Q

What time scales are considered very premature and miscarriage?

A
  1. <34 weeks - very premature

2. <24 weeks - miscarriage

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3
Q

What are the causes of delivery before term?

A
  1. 40% unknown cause
  2. Multiple pregnancy, polyhydramnios, pre-eclampsia, IUGR, infection, placental abruption.
  3. Uterine abnormalities, cervical incompetence.
  4. Infection (BV, GBS, trichomonas, chlamydia)
  5. UTI, poor dental hygiene
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4
Q

What are the risk factors for delivery before term?

A

History or preterm delivery, extremes of maternal age, short interpregnancy interval, CKD, DM, thyroid disease, PET, IUGR, high Hb, male, STI, UTI, cervical surgery, multiple pregnancy, uterine abnormalities, polyhydramnios, congenital foetal abnormalities, antepartum haemorrhage.

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5
Q

How is delivery before term prevented?

A
  1. Cervical cerclage (keep closed)
  2. Progesterone supplementation
  3. Treat infection
  4. Foetal reduction
  5. Polyhydramnios treatment
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6
Q

What is this a presentation of?

Painful contraction, stops spontaneously in 50%, fluid loss could be present, dilated cervix, 35/40.

A

Potential for delivery before term.

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7
Q

How would you assess the likelihood of delivery in potential preterm delivery?

A
  1. If cervix unaffected - foetal fibronectin assay (should not be in vaginal secretion until 36/49.
  2. If negative, preterm delivery unlikely
  3. TV USS to assess cervical length, >15mm = unlikely to deliver.
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8
Q

How would you assess foetal state in potential preterm delivery?

A

CTG and USS

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9
Q

How would you assess infection in potential preterm delivery?

A
  1. Vaginal swabs
  2. Urinalysis and dip
  3. CRP and WCC
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10
Q

What are the five aspects of management in preterm delivery?

A
  1. Steroids
  2. Tocolysis
  3. Infection treatment
  4. Magnesium sulphate
  5. Delivery
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11
Q

What is the steroid regime for preterm delivery?

A
  1. Give between 23-34 weeks, IM betamethasone

2. Takes 24 hours to work so delivery is delayed using tocolysis

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12
Q

What is the tocolysis regime for preterm delivery?

A
  1. Nifedipine or oxytocin receptor antagonist
  2. Allows steroids time to act
  3. Delay labour, do not stop it
  4. Maximum use of 24 hours, do not use in infection
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13
Q

What is magnesium sulphate used for in preterm delivery and what is the regime?

A
  1. Neuroprotective for neonate
  2. Give <12 hours prior to planned delivery
  3. 4g IV between 23-34 weeks
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14
Q

What is the benefit of a vaginal preterm delivery?

A

Reduces neonatal respiratory distress syndrome

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15
Q

What should you do with babies born <28/40?

A

Wrap in plastic bag and kept under heat, 3 min delay in cutting cord (unless resus needed).

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16
Q

What is the definition of preterm rupture of membranes?

A

Membranes rupture before labour at <37/40.

17
Q

What are the complications of preterm rupture of the membranes?

A
  1. Preterm labour
  2. Chorioamnionitis
  3. Cord prolapse
18
Q

What are the clinical features of preterm rupture of membranes and chorioamnionitis?

A
  1. Gush of clear fluid, followed by further leaking.

2. Abdominal pain, fever, tachycardia, coloured/offensive liquid.

19
Q

What are the steps of investigation after a suspected preterm rupture of membranes?

A
  1. Confirm with Actim Partus test
  2. High vaginal swab, FBC, CRP, temperature, MSU
  3. CTG - persistent tachycardia suggests infection
20
Q

What is the management of preterm rupture of membranes?

A
  1. Admit for 48 hours
  2. Give steroids and erythromycin 500mg QDS for 2 weeks.
  3. If infection - IV Abx and deliver regardless of gestation
  4. If labour does not occur spontaneously after 48 hours - discharge, weekly follow up, aim to deliver by 34/40.

O&G: Obstetrics (36 decks)

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