premature labour

what is prematurity defined as?

birth <37 weeks gestation

what is extreme preterm?

<28 weeks

what is very preterm?

28-32 weeks

what is moderate to late preterm?

32-37 weeks

what is the prophylaxis of preterm labour?

- vaginal progesterone

- cervical cerclage

when is vaginal progesterone offered?

cervical length <25mm on vaginal ultrasound between 16-24 weeks gestation

why is the length of the cervix important?

cervix shortens to prepare for labour

what is cervical cerclage?

putting a stitch in the cervix to add support and keep it closed

when is cervical cerclage offered?

cervical length <25mm on vaginal ultrasound between 16 and 24 weeks gestation

when is "rescue" cervical cerclage offered?

between 16 and 27+6 weeks when there is cervical dilatation without ROM - to prevent premature delivery

what is PROM?

prelabour rupture of membranes - when the amniotic sac ruptures before labour

what is P-PROM?

pre-term prelabour rupture of membranes - before onset of labour and in a preterm pregnancy

how can rupture of membranes be diagnosed?

sterile speculum examination revealing pooling of amniotic fluid in vagina - no tests needed

what tests can be performed if exam is unclear?

- insulin-like growth factor-binding protein-1 (IGFBP-1)

- placental alpha-microglobin-1 (PAMG-1)

what will be the results of IGFBP-1 and PAMG-1 in ROM?

high concentrations in amniotic fluid - so positive in ROM

what should be given if P-PROM has taken place?

prophylactic antibiotics to prevent chorioamnionitis

what antibiotics are recommended by NICE?

erythromycin 250mg QD for 10 days or until labour is established if within 10 days

what is the triad of clinical features for chorioamnionitis?

in a women in Pre-PROM

- foetal tachycardia

- maternal tachycardia

- maternal pyrexia

when can induction of labour be offered after P-PROM?

from 34 weeks

what is preterm labour with intact membranes?

regular painful contractions and cervical dilatation without rupture of amniotic sac

how would you diagnose a preterm labour with intact membranes at <30 weeks gestation?

clinical assessment including speculum examination to assess for cervical dilatation is enough

how would you diagnose a preterm labour with intact membranes at >30 weeks gestation?

transvaginal ultrasound used to assess cervical length

at what cervical length would a pt be treated as preterm labour with intact membranes?

<15mm

what is an alternative test to vaginal ultrasound?

foetal fibronectin

what is foetal fibronectin?

"glue" between chorion and uterus - found in the vagina during labour

what is considered a negative foetal fibronectin test result?

<50ng/ml - preterm labour unlikely

what are the management steps for improving outcomes in preterm labour?

- foetal monitoring

- tocolysis with nifedipine

- maternal corticosteroids

- IV magnesium suplhate

- delayed cord clamping or cord milking

what is tocolysis?

using medications to stop uterine contractions

what is the first line for tocolysis?

nifedipine - CCB

what is an alternative to nifedipine?

atosiban - oxytocin receptor antagonist

when can tocolysis be used?

between 24 and 33+6 weeks

what does giving the mother corticosteroids do?

mature foetal lungs to reduce respiratory distress syndrome after delivery

when are corticosteroids given?

suspected preterm labour <36 weeks

how are the corticosteroids given?

2 doses IM - 24 hours apart

what is an example of a corticosteroid used?

betamethasone

what does giving the mother IV magnesium sulphate do?

helps protect the foetal brain during premature delivery - reducing the risk and severity of cerebral palsy

when is magnesium sulphate given

within 24 hours of delivery of babies <34 weeks gestation

why do mothers need to be closely monitored after magnesium sulphate?

check for magnesium toxicity

what should be monitored?

- respiratory rate

- reflexes

what are the key signs of magnesium toxicity?

- reduced RR

- reduced BP

- absent reflexes

how do you treat magnesium induced respiratory depression?

calcium gluconate -

what does delayed cord clamping/cord milking do?

increase the circulating blood volume and haemoglobin in the baby at birth