5. iatrogenic: interests of fetes eg IUGR, mother eg PET (delivery is only cure)
which Ix can predict preterm labour?
transvaginal scan: measure cervical length
need to have empty bladder
how is preterm labour prevented?
1. cervical cerclage: suture to strengthen it and keep it closed. elective at 12-14 weeks if previous hx of incompetence; if significant shortening on scan; rescue suture when incompetent cervix is dilated
2. infection: treat STIs and BV
3. fettle reduction: reduce higher order multiples at 10-14 weeks
4. treat polyhydramnios - needle aspiration (amnioreduction) or NSAIDs which reduce fettle urine output BUT may cause premature closure of fettle ductus arterioles
5. progesterone supplementation: suppositories from early pregnancy reduce risk of preterm in high risk women
what are the symptoms of preterm labour?
1. painful contractions (in over half - contractions will stop spontaneously and labour at term)
2. painless cervical dilatation in cervical incompetence
3. APH, fluid loss - ROM
what should be monitored in a patient with preterm labour?
2. abdominal tenderness
3. lie and presentation
4. fettle heart rate
5. maternal pulse
6. checking for vaginal loss - avoid VE
which investigations are done in preterm labour?
1. CTG - assess fettle state
2. to assess likelihood of DELIVERY: if cervix is UNEFFACED, fettle fibronectin. high NPV (-ve FFN means delivery is unlikely)
3. TVS of cervical length. if long > 15mm, delivery extremely unlikely
4. infection: high vaginal swabs using STERILE SPECULUM if ROM,
5. CRP rises with chorioamnionitis
6. WCC may be high due to steroids
name 3 aspects to the management of preterm labour?
1. steroids: dexamethasone 10mg x 2 12 hours apart to reduce RDS as increase fettle surfactant production
2. tocolysis eg oxytocin antagonist atosiban (or salbutamol, terbutaline, NSADs but used less as SE). tocolysis for 2 purposes: time for steroids to work, time for in uteri transfer to unit where neonatal care facilities
3. antibiotics esp if suspect chorioamnionitis or ROM give erythromycin
INFORM PAEDS ALWAYS
which type of assisted delivery is contraindicated in preterm labour?
what is preterm prelabour ROM?
when membranes rupture BEFORE LABOUR at < 37 weeks
happens in 1/3 of preterm deliveries
what are the complications of PROM?
1. preterm delivery happened in 48h in >50% of cases