Preterm labour Flashcards Preview

A1. Women's Health > Preterm labour > Flashcards

Flashcards in Preterm labour Deck (18):
1

What is the definition of preterm labour?

Delivery before 37 weeks

2

Name 5 reasons besides spontaneous preterm labour for labour before 34 weeks

PROM/infection (chorioamnionitis)
Multiple pregnancy
APH
HT/pre-eclampsia
Foetal growth restriction

3

Name 5 ways to prevent preterm labour

Lifestyle modification - education, bed rest
Cervical cerclage (stitch)
Prophylactic tocolysis
Uterine activity monitoring
Optimise maternal condition
Control vaginal infection

4

Name ways of predicting onset of preterm labour

Uterine activity monitoring
Serial cervical assessment (length - short length = more chance of cervical incompetance)
Cervicovaginal microbiology/biochemistry - foetal fibronectin

5

How is foetal fibronectin useful in predicting preterm labour? How do you test for it?

Foetal fibronectin released during subclinical uterine contractions. Swab posterior fornix for fibronectin - high negative predictive value (no fibronectin = low chance of delivery)

6

Name the 4 classes of tocolytics. Which is the most widely used and why?

Calcium antagonist (Nifedipine) - most widely used (fewest SE)
Beta-adrenergics (Salbutamol, ritodrine, Terbutaline)
MgSO4
PGE2 inhibitors (Indomethacin)

7

Name a maternal, foetal and placental contraindication to beta-adrenergic tocolysis

Maternal - cardiac disease, PE, HT, hyperthyroidism, DM, PROM, sepsis
Placental - placental abruption, bleeding praevia
Foetal - gestation 32 weeks, growth restriction, FDIU, lethal abnormality, advanced labour

8

What is the most important thing to remember when considering giving a tocolytic? Give three reasons you might use tocolysis

Only give tocolytic if it will improve outcome, not just to delay onset of labour

Might use tocolysis to allow transfer to suitable facility, cortisol administration, or MgSO4 administration

9

Go through the role of endogenous steroids in normal labour.

Before delivery, foetal pituitary releases ACTH and cortisol to stimulate prostaglandin and oestrogen release from placenta. This induces labour, as well as lung maturation.

10

What are two benefits of giving exogenous steroids in premature labour? To which women and when should you give it?

Reduce incidence of respiratory distress (from lung maturation) and necrotising enterocolitis.

Give to women under 34 weeks, less than 1 week before delivery

11

What disease does MgSO4 reduce the incidence of? To which women and when should you give it?

Cerebral palsy. Give to women under 30 weeks, less than 4 days before delivery

12

What is the difference between premature rupture of membranes and prelabour rupture of membranes?

Prelabour rupture of membranes = ROM in term baby, before labour commences
Premature ROM = ROM in preterm baby

13

Name 5 causes of PROM

Idiopathic/unknown
APH
Congenital membrane weakness
Uterine anomaly
Genital tract infection

14

Name 4 signs/symptoms of PROM

Small-for-dates uterus (loss of liquor)
Vaginal fluid loss
Odour
Alkaline pH

15

What is the main Ddx of PROM? What is a test that can be done to distinguish this from PROM?

Urinary incontinence. Can do pyridium test on vaginal discharge - if positive = urine

16

Name 5 Ix for PROM

Speculum Ex, high vaginal swab (Ferning test of cervical mucus)
CTG
U/S
FBE + CRP

17

Name 3 maternal and foetal complications of PROM

Maternal - genital tract infection, haemorrhage, C/S, anxiety
Fetus - prematurity, chorioamnionitis, umbilical cord compression, pulmonary hypoplasia (lungs need amniotic fluid for movements), limbcontractures

18

Name 5 management considerations for PROM

Admission?
Active vs conservative management of delivery
Tocolysis vs oxytocics (only give tocolytics if transport needed)
Antibiotics (usually erythromycin)
Steroids, MgSO4
Need for amniocentesis (infection?) or amnioinfusion