PROM Flashcards

1
Q

Define pre-term labour

A

Onset of labour (regular, painful contractions a/w progressive cervical changes with/without ROM)

< 37 completed wks of gestation

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2
Q

List some complications of PTL more significant in gestations < 34wks?

A

HMD, ICH, infections, NEC

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3
Q

Outline the management principles of PTL

A

Assess gestation

Establish the diagnosis

Ascertain a cause

Decide on tocolysis/steroids

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4
Q

Define tocolytic

A

Drug used to suppress labour

In order to administer steroids to enhance fetal lung maturity

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5
Q

For how long are tocolytics continued?

A

48 hrs

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6
Q

What is the dosage of nifedipine (tocolytic drug of first choice and CCB, ‘Adalat’) used in PTL?

A

Initially: 30mg orally then 20mg after 90min

If contractions persist: 20mg 6hrly

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7
Q

What are two NB C/I’s to CCB (Nefidipine, ‘Adalat’)?

A

Hypovolaemia

Cardiac conditions

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8
Q

What is the MOA of B2 adrenergic agents (e.g. salbutamol, ‘Ventolin’) as a tocolytic agent, and what are some of its S/E’s?

A

Uterine smooth muscle relaxant

Maternal and fetal tachycardia, hyperglycaemia

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9
Q

What are some common S/E’s of CCB (e.g. nefidipine, ‘Adalat’) tocolysis?

A

Headache

Flushing

Nausea

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10
Q

What is the dosage of salbutamol (Ventolin) used for tocolysis?

A

250mcg diluted in 9.5mL water as slow IV bolus

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11
Q

What are 4 NB C/I to B2 adrenergic tocolysis?

A

Stenotic valvular lesions

Shock

DM

Thyrotoxicosis

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12
Q

What is the MOA of prostaglandin antagonists (e.g. indomethacin) in tocolysis?

A

Blocks the conversion of AA to prostaglandin E2 and F2α

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13
Q

What is the dosage of indomethacin used in tocolysis?

A

100mg rectally 12hrly for 48hrs

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14
Q

What are S/E’s of prostaglandin antagonists (e.g. indomethacin) in tocolysis?

A

GIT irritation

RF

Supression of platelet function

Premature closure of ductus arteriosus

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15
Q

What are 3 NB C/I to prostaglandin antagonist (e.g. indomethacin) tocolysis?

A

Throbocytopaenia

Peptic ulcer disease

Fetal gestation > 32 wks

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16
Q

Name the tocolytic not used in state hospitals (expensive) and outline its MOA

A

Atosiban

Oxytocin receptor antagonist (blocks oxytocin reeptors in the uterus)

17
Q

When may a rescue course of steroids be given?

A

If the initial dose is given at very early gestation (e.g. 27 wks)

18
Q

What did the ORACLE III trial show wrt antibiotic use in PTL?

A

No benefit except in those in whom ROM had also occurred

19
Q

Define prelabour preterm ROM (PPROM)

A

Leakge of amniotic fluid through the cervix

< 37wks of gestation

Must be differentiated from heavy vaginal discharge or involuntary passage of urine

20
Q

List 7 causes of ROM < 37 wks (i.e. PPROM)

A
  1. intra-uterine infection
  2. Incompetent cervix
  3. Iatrogenic ROM (IOL)
  4. Interference (a/w infection)
  5. Complication of amniocentesis
  6. Complication of ECV
  7. Uterine overdistension (e.g. polyhydramnios, multiple pregnancy)
21
Q

Outline the management principles of PPROM

A

> 35wks: deliver

< 34wks: conservative

22
Q

Outline the conservative management of PPROM

A

Bed rest

Sterile pads changed 2hrly

Avoid PV’s

Adminster steroids

Assess fetal growth, amniotic fluid

Monitor for signs of maternal infection (CTG, clinical exam, twice weekly WCC + CRP)

Oral antibiotics e.g. erythromycin

Deliver if signs of intrauterine infection or fetal distress