Pregnancy complications - Preterm labour Flashcards
(31 cards)
What is preterm birth?
Delivery between 24 and 37 weeks
What are risk factors for pre-term labour?
-
Uterine factors
- Multiple pregnancy
- Polyhydramnios
- APH
-
Cervical factors
- Previous cervical surgery - large LLETZ, trachelectomy
- Cervical incompetance
-
Maternal factors
- Infection eg UTI
- Previous pre-term labour
- Previous PROM
- Race
- BMI
- Age
- Alcohol
- Smoking
- Social factors
-
Iatrogenic factors
- Severe pre-elcampsia
- IUD
- IUGR
- Idiopathic
How does preterm labour associated with infection/inflammation/abruption tend to present?
- Lower abdominal pain
- Painful uterine contractions
- Vaginal loss
What commonly occurs before preterm labour which can indicate that it is about to happen?
Spontaneous rupture of membranes (SRM)
What would you want to ask about in the history in someone who is presenting in preterm labour?
- Pain/contractions - onset, frequency, duration, severity
- Vaginal loss - PV bleeding, SROM
- Obstetric history
How would you examine someone with acute preterm labour?
- Observations - pulse, RR, Temperature
- Uterine tenderness
- Foetal presentation
- Speculum
- Gentle VE
What investigations would you consider doing in someone with preterm labour?
- Bedside - Swabs, Dipstick, Foetal CTG
- Bloods - FBC, CRP, foetal fibronectin
- Imaging - USS
How would you manage someone in preterm labour?
- Treat cause - may help
- Admit if high risk and warn neonatal unit
- Check foetal presentation
- Consider tocolytic medications
- IM steroid
- IV antibiotics
When are tocolytic drugs normally used?
Threatened preterm labour for 24-35 weeks
What are the main uses for tocolytics when given to women in preterm labour between 25-37 weeks gestation?
- Facilitate transfer to appropriate facilites
- Give steroid treatment more time to work
What durgs can be used for tocolysis?
- CCBs - nifedipine
- Oxytocin receptor antagonists - Atosiban
- B2 agonists - terbutaline, salbutamol
- Magnesium sulphate - used for neuroprotection of baby
- Indomethazin
When is tocolysis indicated for acutely?
- Foetal distress
- Need for emergency CS
- Obstructed labour
- Hypertonic uterus causing foetal distress
What drugs would you use when trying to acutely tocolyse a woman in preterm labour?
- Terbutaline
- GTN
Why would you give steroids to someone in preterm labour?
Reduces rates of:
- Foetal respiratory distress (matures foetal lungs by increasing surfactant production)
- Intraventricular haemorrhage
- Neonatal death
Also closes PDA
What dose of steroids is used in the management of preterm labour?
Betamethasone/dexamethasone - 2 x 12mg given 24 hrs apart
Why is it important to start steroids as early as possible in someone in preterm labour?
Can take 12-24 hours for the full course therefore it is best to avoid delays in administration
When are steroids indicated for in preterm labour?
- Risk of preterm labour
- Threatened SROM
- Medical need to expidite delivery
What are absolute contraindications to tocolysis?
- Chorioamnionitis
- Foetal death
- Condition needing immediate delivery
What is foetal fibronectin?
A glycoprotein not usually detected in vaginal secretions between 22-36 weeks. It is found in the cervico-vaginal secretions before 21 weeks (so shouldn’t be there after this time). Inflammation/trauma leads to its secretion into the cervix/vagina.
If engative, unlikely to be labour
If positive, high risk of preterm labour.
What does a +ve foetal fibronectin indicate?
10% risk of preterm pregnancy
How would you manage PROM?
- Admit for 48hrs
- Rule out sepsis/chorioamnionitis
- Give steroids
- Give erythromycin (10 days) - reduce neonatal infection without enterocolitis
- Manage labour - if that is the outcome
- If no labour in 48hrs - discharge and manage as outpatient
What is the biggest risk with PROM?
Intrauterine infection - increasing risk as time goes on
What is regarded as extremely preterm?
<28 weeks
What is regarded as very preterm?
28-32 weeks
