Premature Labour/PROM Flashcards
ROM Definition
Rupture of membranes: The amniotic sac has ruptured
SROM Definition
Spontaneous rupture of membranes: The amniotic sac has ruptured spontaneously
PROM Definition
Prelabour rupture of membranes : The amniotic sac has ruptured before the onset of labour
PROM Definition
Prolonged rupture of membranes: The amniotic sac ruptures more than 18 hours before delivery.
Prematurity
Birth before 37 weeks gestation. The more premature the baby, the work the outcomes
Non-viable
Below 23 weeks gestation
- Generally between 23-24 weeks = resus not considered in babies that do not show signs of life.
- From 24 weeks onwards = increased chance of survival and full resuscitation is offered
WHO prematurity classification
Under 28 weeks: extreme preterm
28 – 32 weeks: very preterm
32 – 37 weeks: moderate to late preterm
Prophylaxis of preterm labour
Vaginal Progesterone: Decrease activity of the myometrium and prevents the cervix remodelling in preparation for delivery. Offered to women with cervical length <25mm on USS between 16-24 weeks gestation
Cervical Cerclage: Stitch in the cervix to add support and keep it closed = Spinal or general anaesthetic. Removed when the women goes into labour or reaches term.
Cervical cerclage offered <25mm on vaginal USS between 16-24 weeks gestation, who have had a previous prem birth or cervical trauma (e.g. colposcopy and cone biopsy).
“Rescue” cervical cerclage
Offered between 16 and 27+6 weeks when there is a cervical dilatation without rupture of membranes to prevent progression and premature delivery.
Preterm premature ROM
Where the amniotic sac ruptures, releasing amniotic fluid, before the onset of labour and in a preterm pregnancy (under 37 weeks gestation).
Diagnosis of ROM
Speculum examination = pooling of amniotic fluid into vagina.
Consider if doubt of Dx:
- Insulin-like growth factor-binding protein-1 (IGFBP-1) = high concs in amniotic fluid
- Placental alpha-microglobin-1 (PAMG-1) = similar alternative to IGFBP-1
Management of preterm PROM
Prophylactic Abx to prevent = chrorioamnionitis.
FL = ERYTHROMYCIN 250mg 4 times daily for 10 days or until labour is established if within 10 days
Induction of labour may be offered from 34 weeks to initiate the onset of labour.
Preterm labour within intact membranes definition
Regular painful contraction and cervical dilatation, without rupture of the amniotic sac.
Diagnosis of preterm labour with intact membranes
Clinical assessment = speculum examination to assess for cervical dilatation.
< 30 weeks gestation: clinical assessment alone enough to offer Mx
> 30 weeks gestation: transvaginal USS to assess cervical length.
- USS < 15mm = Mx of preterm labour can be offered.
15mm indicates preterm labour = unlikely.
Fetal fibronectin
Alternative test to TVUS = the “glue” between the chorion and the uterus and is found in the vagina during labour.
< 50ng/ml = - ve = preterm labour unlikely.
