Pre-term Labour

Question 1

What is preterm labour?

Answer 1

• regular contractions with cervical change at <37 wks gestation
• very preterm - <32 wks
• extremely preterm - <28 wks

Question 2

What are some of the pre-disposing factors?

Answer 2

• PPROM
• hypertensive disorders
• IUGR
• abruption and praevia
• multiple pregnancy
• cervical weakness
• uterine malformation

Question 3

What is threatened preterm labour?

Answer 3

• presence of uterine contractions in absence of cervical changes

Question 4

What are some of the causes of preterm labour?

Answer 4

• maternal fever
• acute pyelonephritis
• acute appendicitis
• abdominal operation
• hypertension, nephritis, diabetes, severe anaemia
• decompensated heart disease
• PIH
• APH
• cervical weakness
• malformation of uterus
• multiple pregnancy
• PROM
• hydramnios
• congenital fetal malformation
• idiopathic
• prev history of preterm birth

Question 5

What are some of the risk factors?

Answer 5

• non white race
• prev preterm delivery
• low BMI
• extremes of age (<17 and >35)
• strenuous work stress
• tobacco use
• hb <100g
• bacteruria
• low socioeconomic status
• fetal death
• domestic violence
• hypertensive disease
• infection

Question 6

What are some of the signs and symptoms?

Answer 6

• persistent contractions associated with cervical changes
• intermittent abdominal cramping, pelvic pressure or backache
• increase in vaginal discharge
• vaginal spotting or bleeding
• ?SROM

Question 7

What is the midwives role?

Answer 7

• refer - obstetrician, paed
• SBAR
• prepare parents for next assessments and actions

Question 8

How might you screen for preterm labour?

Answer 8

• infection key trigger
• urinalysis
• MSU
• HVS
• maternal observations

Question 9

What is fetal fibronectin?

Answer 9

• glycoprotein produced by the chorion
• presence after 24 wks is a marker for the disruption of the chorioamnion and underlying decidua due to inflammation with or without infection
• swab should be taken from posterior fornix or ectocervix

Question 10

What is transvaginal ultrasound?

Answer 10

• may be used to assess risk of PTL

- measures cervical length and funelling

Question 11

When is cervical cerclage used?

Answer 11

• elective or preventative procedure, conducted on the basis of previous history or ultrasound findings
• or as an emergency when the cervix is found to be effacing and dilating at a previable gestation

Question 12

What are some of the complications of cervical cerclage?

Answer 12

• ROM
• bleeding
• pregnancy loss
• bladder injury
• abdominal sutures remain in situ and are not removed and baby delivered by CS
• McDonald and shirodkar sutures removed if labour occurs or at 37 wks

Question 13

What is the midwives role in PTL?

Answer 13

• drug administration
• observation of maternal condition
• titrate medication related to observations
• explanation and reassurance
• reporting changes
• being alert
• preparation for pre term birth - visit NNU if possible

Question 14

What is the midwives role in labour?

Answer 14

• support
• communication between parents and paed
• preparation for birth
• resuscitation more likely - set at 20cm
• equipment and environment
• assess maternal and fetal well being
• labour usually more rapid
• confirm presentation and position

Question 15

What are some of the issues with PTB?

Answer 15

• CTG interpretation more difficult
• consider episiotomy if appropriate
• ventouse not appropriate
• keep membranes intact
• plastic bag ready if <32 wks
• labels availability to attach to baby
• hats available

Question 16

What should happen at the birth?

Answer 16

• skin to skin if possible depending on gestation
• plastic bag
• delay cord clamping if possible
• cord gases to asses and plan initial care
• active 3rd stage as retained placenta increases in younger gestation
• care with cord traction
• placenta histology