Preterm Labour Flashcards
(27 cards)
What is the difference between labour and delivery?
“Labour” refers to the process of childbirth, beginning with the onset of contractions that lead to the opening of the cervix and culminating in the birth of the baby. “Delivery” specifically refers to the moment when the baby is born and is separated from the mother’s body, usually through the vaginal canal or via a surgical procedure like a cesarean section. In summary, labour encompasses the entire process of childbirth, whereas delivery specifically refers to the moment of the baby’s birth.
The most Common causes of postpartum hemorrhage can be lumped into 4 groups
Causes of preterm labour
1-cervical weakness
2- infection
3-uterine overdistension
4- mullerian anomalies
5- hemmorrhage
6-stress
7- intercurrent illness
Risk factor for cervical weakness
1-history of cervical surgery
2- short cervical length
Infection of the fatal membranes is called
Chorioamnionitis
Causes of chorioamnionitis
1- ascending infection
2- transplacental route
3-invasive procedures
Causes of uterine over-distension
1-polyhydramnios
2- multiple pregnancy
Why overdistension of uterus initiate labour
Myometrial stretch has been shown to result in up-regulation of oxytocin receptors and pg production
Why stretch of fatal membranes initiate Labour
Due to production of pg and cytokines
Why illness of the mother due to appendicitis or pyelonephritis or pneumonia, are associated with preterm labour?
The cause either direct, when infection spread directly into the uterine cavity, or indirect when the chemical triggers such as endotoxins or cytokines cause the problem
Acute bleeding effect on myometrium
Released Thrombin directly stimulates myometrial contractions
Why subchorionic hematoma increase the risk of PPROM
Either through the effect of
Thrombin on membranes strength or through the occurrence of infection in the hematoma
Prematurity is common among women reporting increased stress or anxiety
The biochemical pathway is unclear but it may involve increased circulating levels of CRT
Main problems with preterm babies
1- respiratory distress syndrome
2- chronic lung disease
3- patent ductus arteriosus
4-jaundice
5-parenchyma cerebral hemmorrhage
6- infection
7- hypoglycemia
Preterm labour is of 2 types
1-real (with cervical changes)
2-threatened ( no cervical changes)
70% of women with threatened preterm labour will not deliver during current admission, 50% of them will not deliver until birth
Ok
Fibronectin assay
This test measure the presence of fibronectin in Vaginal secretions coming from amniotic fluid
Benefits of antenatal steroids in preterm labour
Reduce the risk o
1- respiratory distress
2- intraventricular hemmerrhage
3- neonatal death
Why tocolytics are used?
To delay delivery long enough for corticosteroids administration to improve neonatal lung function
Role of magnesium sulphate
Neuroprotection
Which group of patients have to have steroids therapy?
1 - antepartum hemmorrhage
2- preterm rupture of membranes
3- threatened preterm labour
4- growth restriction
5 - chorioamnionitis
6- any condition requiring elective preterm delivery
Which steroids used in preterm
Betamethasone
Dexamethasone
Repeated courses of corticosteroids are not recommended in pregnant women
Due to the risk of developing side effects in both baby and mother
Contraindication of tocolytics
1- placental abruption
2- cervical dilation
3- severe pre-eclampsia
4-intrauterine infection
