Prematurity

Question 1

What is prematurity?

Answer 1

Birth before 37 weeks gestation

Question 2

What is the WHO classification of prematurity?

Answer 2

<28 weeks = extreme preterm
28-32 weeks = very preterm
32-37 weeks = moderate to late preterm

Question 3

What can prematurity be associated with?

Answer 3

1. Smoking
2. Alcohol
3. Drugs
4. Overweight or underweight mother
5. Maternal co-morbidities
6. Twins
7. Personal or family history of prematurity

Question 4

What are the 2 options for delaying birth in women with a history of preterm birth or a cervical length of 25mm or less before 24 weeks gestation?

Answer 4

Prophylactic vaginal progesterone - putting progesterone suppository in the vagina to discourage labour

Prophylactic cervical cerclage - putting a suture in the cervix to hold it closed

Question 5

How can the outcome be improved where preterm labour is suspected or confirmed?

Answer 5

1. Tocolysis with nifedipine - this is a CCB that suppresses labour
2. Maternal corticosteroids - can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
3. IV magnesium sulphate - can be offered before 34 weeks and helps protect the baby’s brain
4. Delayed cord clamping or cord milking - can increase the circulating blood volume and Hb in the baby

Question 6

What are some issues in early life with prematurity?

Answer 6

1. RDS - due to immature lungs
2. Hypothermia - due to difficulty regulating body temperatures
3. Hypoglycaemia - due to limited glycogen stores
4. Poor feeding - due to immature reflexes
5. Apnoea and bradycardia - due to autonomic nervous system immaturity
6. Neonatal jaundice - due to liver immaturity
7. Intraventricular haemorrhage
8. Retinopathy of prematurity
9. Necrotising enterocolitis (inflammation and necrosis of the bowel)
10. Immature immune system and infection

Question 7

What are the long term effects of prematurity?

Answer 7

1. Chronic lung disease of prematurity
2. Learning and behavioural difficulties
3. Susceptibility to infections, particularly respiratory tract infections
4. Hearing and visual impairment
5. Cerebral palsy