Preterm Labour and Birth

Little Babies

100

Any delivery before 37+0 weeks gestation and occurs in about 8% of pregnancies

What is Preterm Birth

200

It's definition is having regular uterine contractions with progressive cervical dilation and/or effacement at >20⁰ and <37⁰ weeks gestation

What is Preterm Labour

300

What are 5 risk factors for induced (iatrogenic) preterm birth?

• pre-eclampsia
• complicated insulin-dependent diabetes mellitus
• abnormal fetal surveillance results
• intrauterine growth restriction
• placental abruption
• intrauterine death
• chorioamnionitis
• monochorionic, monoamniotic twins

400

What are 5 risk factors for spontaneous preterm labour?

• REPRODUCTIVE HISTORY 
  •  prev. spontaneous preterm birth, advanced reproductive technologies
• ANTEPARTUM BLEEDING
• PPROM
• CERVICAL FACTORS
  • cervical insufficiency, uterine malformation, fibroids, prev. excisional cervical treatment
• FETAL/INTRAUTERINE FACTORS
  •  multifetal gestations, fetal anomaly, polyhydramnios
• INFECTION 
  • chorio, bacteriuria, periodontal disease, current BV, malaria, hep B
• Demographic factors: 
  • low socioeconomic status, single martial status, low level of education, maternal age <18 or >35 years

500

What are preterm newborns at increased risk for after delivery?

What is requirement for resuscitation and assistance with transition after birth

They are at an increased risk of complications because of rapid heat loss, immature organ systems, small blood volume and vulnerability to hypoglycemia

Risk and Prevention

100

Preterm birth is a major cause of perinatal morbidity and mortality and is estimated to account for __% of neonatal mortality.

A. 50%
B. 60%
C. 75%
D. 90%

C. 75%

200

What medication has been shown to decrease the risk of PTB in singleton pregnancies under 34⁰ wks with a shortened cervix (< 25mm)

What is Progesterone.

What are the various routes of administration?

300

What should be considered in patients with a cervix <25mm before 24⁰ wks if they have a prior history of preterm birth or a prior hx of suspected cervical incompetence

What is a cervical cerclage

400

The increased use of antenatal steroids have reduced occurrence and consequences of complications of RDS with preterm births. 

What are the names of the steroids that can be given if there is concern for PTL and/or PTB

What is Betamethasone and Dexamethasone. 

What is the dosage/frequency?

500

Which type of cerclage cannot be removed during labour and requires a cesarean delivery?

What is an abdominal cerclage. 

Done laparoscopically, suture is placed at the internal os and usually done for patients whose vaginal cerclage failed or is not possible

Assessment

100

The mean length at 24⁰ to 28⁰ weeks is 34mm to 35mm. 

What is the cervical length?

The probability of PTB increases when the length is less than 25mm to 30mm, in a singleton pregnancy, (20mm in twins). 

200

It is a glycoprotein whose presence in cervicovaginal secretions before 34⁰ weeks is associated with preterm labour and birth

What is Fetal Fibronectin

300

What type of imaging is the gold standard for measuring cervical length?

Transvaginal Ultrasound

400

Identify the 6 steps for an assessment of preterm labour

1) Review history - EDD, ultrasounds, prenatal record and clinical growth

2) VS and FHS

3) Obtain urine for C+S

4) Evaluate labour - frequency, intensity, duration, changes with time,

5) Cervical Assessment - sterile speculum for FFN, ?PPROM, culture swabs for G+C, GBS (if not done yet)
- defer digital examination until after confirmation membranes are intact and there is no placenta previa

6) Evalutate lab results - CBC for leukocytosis

500

What neonatal assessment should be considered if corticosteroids were given for late preterm delivery?

What is increased monitoring and glucose checks for hypoglycemia. 

A 2016 study showed administration of betamethasone significantly reduced the rate of neonatal RDS. Neonatal hypoglycemia was more frequent. 

Treatment and Therapy

100

What group of medications have been shown to prolong pregnancy for 48 hours or more. This is to provide a window of opportunity for administration of glucocorticoids. 

What are tocolytics.

200

What are contraindications for tocolytics?

What is pre-eclampsia, other medical indication for delivery, chorioamnionitis, mature fetus, imminent delivery, IUFD or lethal fetal abnormality

300

If Nifedipine is not tolerated by the patient, what is another tocolytic that can be given

What is Indomethacin 100mg PR or PO (if PR not consented)

400

What type of therapy for fetal neuroprotection should be considered when there is an imminent delivery at <33⁶ weeks?

What is Magnesium Sulphate

500

The rate of MgSo4 loading dose

What is 4g IV over 30 minutes

Delivery Considerations

100

This should be used as a warming measure for a preterm less than 32 weeks

What is a polyethylene bag or wrap

200

This team should always be called for delivery if GA 33wk - 36wks, >42weeks, Fetal Growth Restriction or SGA (<10 centile for gestational age)

Who is Pediatrician

300

This team should be called for delivery if babe is an anticipated NICU admission, GA <33 wks, expected birth weight LESS THAN 1500g

Who is the Neo Resus Team

400

Baby Alfie was born at 32 weeks, NICU team was called for delivery. He required neonatal resuscitation up until PPV was increased to 25. Now NICU is transitioning from resuscitation to stabilization. What is this stabilization period called?

What is Golden hour

500

This is indicated for infants born preterm or newborn who are hospitalized and unable to feed by mouth. This is facilitated by RN teaching/encouraging hand expression, provide birthing parent a collection kit and send it to NICU once collected to give to the babe

What is Oral Immune Therapy