Preterm labour and PPROM Flashcards Preview

Stage 3: EJR - Obstetrics > Preterm labour and PPROM > Flashcards

Flashcards in Preterm labour and PPROM Deck (29):
1

Definition (in terms of gestational age) of preterm labour

Delivery between 24-37w

2

At what gestational age do most foetal complications occur

Before 24w

3

Signs and symptoms of preterm labour

• Increased vaginal discharge
• Mild lower abdominal pain
• Bulging foetal membranes on examination
• Painful uterine contractions

4

Signs and symptoms of PPROM

• “Popping sensation”
• Gush or steady flow of small amounts of watery fluid
• Painless leakage of fluid from vagina (may see meconium in fluid)
• Absence of steady labour contractions

5

Most common causes of preterm labour

-idiopathic
-multiple pregnancy

6

Less common risk factors for preterm labour

• Previous preterm birth
• Previous late miscarriage
• Cervical surgery/ LLETZ
• Antepartum haemorrhage
• Uterine anomalies
• IUGR
• PPROM
• Genital tract infection
• Medical conditions eg renal disease
• Pre-eclampsia
• Antiphospholipid syndrome

7

On measuring cervical length to assess preterm labour, what length is likely to indicate labour

15mm or less

8

What concentration of foetal fibronectin is considered positive

50ng/ml or more

9

If foetal fibronectin is positive, when is preterm birth likely to occur

Within 7-10 days of testing

10

Who should get prophylaxis for preterm labour

-hx of spontaneous preterm birth/ mid-trimester loss between 16 to 34 weeks

-cervical length <25mm between 16 to 24 weeks

11

Types of prophylaxis for preterm labour

-vaginal progesterone

-cervical cerclage

12

Contraindications to cervical cerclage

• Signs of infection
• Active vaginal bleeding
• Uterine contractions

13

Types of tocolysis

-nifedipine
-oxytocin receptor antagonists

14

To what group of pregnant women MUST corticosteroids be given

Women between 26 to 33+6 weeks

15

Why is magnesium sulphate given to mothers going through preterm labour

for neuroprotection of baby

16

First sign of magnesium toxicity

Loss of patellar reflexes

17

Risk factors for PPROM

• Smoking
• Previous preterm delivery
• Antepartum haemorrhage
• Lower genital tract infection

18

Best investigation for diagnosis of PPROM

Speculum exam: look for pooling of amniotic fluids

19

Tests to do on vaginal fluid to support diagnosis of PPROM

• Insulin-like growth factors binding protein-1 test
• placental alpha-microglobulin-1

20

Management of PPROM

-prophylactic antibiotics
-look out for intrauterine infection

21

How to check for intrauterine infection

-CRP
-WBC
-foetal heartrate in CTG

22

Considerations in delivering a baby in a mother who has PPROM

• Consider delivery at 34weeks
• Over 36w: increased risk of chorioamnionitis, reduced risk of respiratory problems for baby

23

If a baby is term and PPROM has happened, by when should the baby be delivered

Before 96h following membrane rupture

(due to infx risk)

24

What causes chorioamnionitis

bacteria ascending uterus from vagina

25

Most common causes of chorioamnionitis

E Coli
Group B Strep
anaerobic bacteria

26

Signs of chorioamnionitis

• Contractions/ abdominal pain
• Fever
• Hypothermia
• Tachycardia
• Uterine tenderness
• Coloured/ offensive liquor

27

Complications of preterm delivery to baby

• Cerebral palsy
• Chronic lung disease
• Blindness, minor disability
• Subtle cognitive & behavioural problems

28

Which corticosteroid is given to women who have undergone PPROM

12mg bethamethasone

29

Which prophylactic a/b is given to women who have undergone PPROM

Erythromycin
BO 250mg QDS