W11_02 Preterm labour and PPROM Flashcards Preview

MMMD 2 > W11_02 Preterm labour and PPROM > Flashcards

Flashcards in W11_02 Preterm labour and PPROM Deck (38)
Loading flashcards...
1
Q

define “term pregnancy”

A

between 37 and 40 weeks

2
Q

define preterm pregnancy

A

before 37 weeks

3
Q

note preterm births account for 75% of perinatal mortality

A

ok

4
Q

what are the three main causes of preterm labour?

A

spontaneous;
PPROM;
indicated preterm birth

5
Q

what are three parts of the labour process?

A

progesterone withdrawal;
oxytocin initiation;
decidual activation (inflammation?)

6
Q

how long before labour does cervical effacement start

A

4-8 weeks pre-labour

7
Q

most risk factors are ASSOCIATED with preterm labour, but are NOT CAUSATIVE

A

ok

8
Q

what’s the biggest risk factor for preterm labour?

A

previous preterm birth

9
Q

what lifestyle factors contribute to preterm labour?

A

smoking, low BMI, high BMI, substance use, stress

10
Q

what demographic factors contribute to preterm labour?

A

age, race/ethnicity, SES, education (all maternal factors)

11
Q

note: women who have bacterial vaginitis have less preterm labour if the infection is treated

A

ok

12
Q

note: multiple pregnancies can increase risk of preterm labour

A

ok

13
Q

note: bleeding is associated with increased risk of preterm labour

A

ok

14
Q

which cervical and uterine issues increase risk for preterm labour?

A

previous spontaneous preterm birth;
uterine anomaly;
cervical insufficiency;
pervious cervical procedure (LEEP, cone)

15
Q

note: short inter-pregnancy interval is associated with increased risk of preterm labour

A

ok

16
Q

note: anemia and thrombophilia are two risk factors for preterm labour

A

ok

17
Q

how to diagnose preterm labour?

A

regular contractions that lead to cervical dilation

18
Q

what’s fetal fibronectin?

A

shouldn’t be present in vaginal secretions before 35 weeks; has a high negative predictive value of preterm labour

19
Q

what’s tocolysis?

A

medical therapy to try and slow down labour

20
Q

what are contraindications to tocolysis? (“need to know”)

A

maternal medical conditions;
chorioamnionitis;
bleeding previa/abruption;
intrauterine growth restriction;
contraindications to specific agents;
mature fetus;
intrauterine fetal demise;
imminent delivery

21
Q

what’re nifedipine, indomethacin?

A

tocolysis agents

22
Q

what’s magnesium sulphate?

A

slows contractions, but not indicated for tocolysis

23
Q

note: mag sulphate, antocin/atosiban/tractocil, ritodrine/terbutaline are NOT indicated for tocolysis

A

ok

24
Q

what infection to screen for in a woman with preterm labour?

A

GBS. If positive, treat. If not, don’t treat. Prevent GBS sepsis in neonate

25
Q

how do steroids help in preterm labour?

A

reduction in rates of neonatal death, RDS, IVH, with associated reduction of NEC, resp support, NICU admission, infections in first 48 hours of life

26
Q

when are steroids beneficial in preterm labour?

A

26-34+6 weeks. But recommended up to 24 weeks

27
Q

which steroids to give for preterm labour?

A

betamethasone and dexamethasone; just one course is good

28
Q

what does magnesium sulphate do?

A

maternal neuroprotection (esp eclampsia);
fetal neuroprotection (cerebral palsy)

29
Q

note: might be good to delay cord clamping in a preterm delivery

A

ok

30
Q

define PPROM

A

preterm premature rupture of membranes

31
Q

how can PPROM lead to neonate death?

A

prematurity;
sepsis;
pulmonary hypoplasia

32
Q

how to diagnose PPROM?

A

speculum exam, and the fluid is seen to pool in the posterior fornix. “Ferning” of fluid sample under the microscope

33
Q

note: check for chorioamnionitis!

A

can become sepsis in mother AND fetus

34
Q

what are signs of chorioamnionitis?

A

maternal vital signs, fetal heart rate, abdominal tenderness/pain, elevation in WBC

35
Q

what are risks of pre-viable PPROM?

A

lung hypoplasia, limb contractures

36
Q

can you give tocolysis in PPROM up to 34 weeks?

A

no

37
Q

how to treat PPROM <34 weeks?

A

antibiotics (erythromycin, ampicillin) shown to help a little

38
Q

how to manage PPROM >34 weeks?

A

toss up - it’s prematurity vs. sepsis

Decks in MMMD 2 Class (64):