Onset of labour before 37 weeks Flashcards Preview

Obstetrics and Gynaecology > Onset of labour before 37 weeks > Flashcards

Flashcards in Onset of labour before 37 weeks Deck (24)
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1
Q

Definition of preterm labour

A

Onset of labour from >20 weeks until 36 + 6 days

2
Q

Common associations (8)

A
Lower SES
Previous preterm
Multiple pregnancy
Uterine structural, cervical incompetence
Infection and PPROM
APH
Polyhydramnios
\+Fetal fibronectin and short cervical length
Poor dental hygeine
Low maternal weight
3
Q

Causes of mortality and morbidity in preterm (7)

A
Respiratory distress
Hypothermia
Hypoglycemia
Necrotising enterocolitis
Jaundice
Infection
Retinopathy of prematurity
4
Q

Assessment: mother and fetus

A
Mother:
History->
Bleeding, fluid, discharge
Dysuria, frequency, flank pain, fever
Polyhydramnios->++girth, ?diabetes
Multiples
Previous preterm, uterine structural
Previous investigations and procedures->CIN, ablation, sutures
Family and social history->poor nutrition, smoking, single, coffee, recreational drugs, alcohol, poor dental hygeine.
Medical, surgical, obstetric

Fetal;
Movement, lie and presentation

Assess for signs and symptoms:
Pelvic pressure, lower abdominal cramping, lower black pain. Vaginal loss. Regular uterine activity

5
Q

How is diagnosis made

A

Presence of regular painful contractions with dilitation and effacement of cervix on sterile speculum/vaginal examination (to avoid in PPROM b/c risk infection)

6
Q

How id diagnosis of chorioamnionitis made

A
>37.5
Abdominal pain
Uterine tenderness
Fetal tachycardia/maternal tachycardia
Offensive vaginal discharge
7
Q

Risk of preterm with previous preterm

A

4X risk

8
Q

Key diagnostic features

A
Risk factors
Uterine contraction
PPROM
\+Cervical dilitation
Cervical length
9
Q

What is threatened preterm labour

A

Preterm uterine contractions without cervical effacement or dilation

10
Q

What is involved in diagnosis

A

Establishing likelihood of delivery
Determining fetal well being
Looking for underlying cause

11
Q

What gives the best prediction of preterm birth

A

Fetal fibronectin + cervical ulrasound

12
Q

When are contractions less likely to be physiological

A

When >1 in 10 minutes

13
Q

Physical examination

A
Vital signs
Abdominal palpation
Fetal surveillance->CTG and tocograph
Sterile speculum:
->identify if ROM
->assess cervix
->high vaginal swab
->test for fetal fibronectin
Low vaginal/anorectal GBS swab
Cervical dilitation->sterile digital vaginal examination unless ROM, PP
USS if available->assess fetal growth and well being
14
Q

Investigations to confirm premature labour

A

Fetal firbonectin
High vaginal/cervical swabs for bacterial infection/Chlamydia/->MCS
Low vaginal for GBS
MSU for MCS

15
Q

What is fetal fibronectin, how performed and when

A

All women presenting with preterm contractions between 24 and 35 weeks’ gestation, who are not in advanced labour (cervical dilation

16
Q

When to consider admission (7)

A
fFN >50ng/ml or
Cervical dilation ot
Cervical change over 2-4 hours or
ROM or
Contractions regular and painful or
Further Ix/management required or
Maternal/fetal concerns
17
Q

Management on admission

A
Analgesia
Clinical surveillance
CTG/fetal monitoring
Transvaginal cervical length if available
Consult
Plan care, prepare for birth
Consider:
In utero transfer
Antenatal steroids
Tocolysis
Antibiotics
Magnesium sulphate
18
Q

Management if admission not required

A

Provide information re: signs and symptoms and returning for care
Arrange follow up as indicated

19
Q

Antenatal corticosteroid regime

A

o Betamethasone: 11.4 mg IM then 2nd dose in 24 hours
o Consider 2nd dose at 12 hours if PTB likely within
24 hours
• If risk of PTB remains ongoing in 7 days, repeat dose

20
Q

Tocolysis regime

A

• Nifedipine 20 mg oral
• If contractions persist after 30 minutes repeat
Nifedipine 20 mg oral
• If contractions persist after further 30 minutes repeat
Nifedipine 20 mg oral
• Maintenance therapy 20 mg every 6 hours for 48
hours
Discuss with Obstetrician/Paediatrician
• If contraindications exist
• If other options required (Indomethacin, Salbutamol)

21
Q

Administer antibiotics if

A

Established labour w/ imminent risk of preterm birth
Evidence of chorioamnionitis
o Ampicillin (or Amoxycillin) 2 g IV initial dose, then
1 g IV every 4 hours
o Gentamicin 5 mg/kg IV daily
o Metronidazole 500 mg IV every 12 hours

If X labour and:
Membranes intact->cease
PPROM->convert to Erythromycin 250mg oral 6qh for 10 days

If hypersensitivity->lincomycin or clindamycin

22
Q

Vaginal or cesarean birth

A

Recommend vaginal unless specific CI/maternal condition necessitates C section

23
Q

Management after threatened preterm labour

A

Care according to clinical needs
Maternal and fetal assessments
T/F back to referring hospital if feasible
D/C when criteria met
Inform woman, GP, care provider about further recommendations of care

24
Q

Magneium sulphate regime

A

• Gestational age 24–30 weeks
• Labour established or birth imminent
o Loading dose: 4 g IV bolus over 20 minutes
o Maintenance dose: 1 g/hour for 24 hours or until
birth – whichever occurs first