Preterm Labour: Managing Risk in Clinical Practice

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Preface......Page 12
Defining the problem......Page 13
Definition of preterm delivery......Page 14
Determination of gestational age......Page 15
Incidence and secular trends......Page 16
Iatrogenic......Page 17
Bacterial vaginosis......Page 18
Chlamydia trachomatis......Page 19
Intrauterine infection......Page 20
Asymptomatic bacteriuria......Page 21
Previous preterm delivery......Page 22
Previous abortion......Page 23
Assisted reproduction......Page 24
Maternal age......Page 25
Race......Page 26
Psychiatric disease and stress......Page 27
Other drugs......Page 28
Antenatal care......Page 29
Summary......Page 30
References......Page 31
Myometrial contractions......Page 38
Organisation of myometrial smooth muscle......Page 39
Calcium and uterine contractions......Page 40
Oestrogen and progesterone......Page 42
Oxytocin......Page 44
Prostaglandins......Page 45
Endothelins......Page 46
Nitric oxide......Page 47
Inflammatory mediators......Page 48
Cervical ripening......Page 49
Structure of the cervix......Page 50
The cervix during pregnancy......Page 51
Cervical ripening......Page 54
The control of cervical ripening......Page 55
Prostaglandins......Page 56
Progesterone and antiprogesterones......Page 57
Inflammatory mediators......Page 58
Nitric oxide......Page 59
Structure of fetal membranes......Page 60
Morphological changes associated with membrane rupture at term......Page 61
Biochemical events associated with membrane rupture at term......Page 62
Preterm premature rupture of the membranes (pPROM)......Page 63
Biology of labour at term......Page 64
Role of infection......Page 66
Summary......Page 68
References......Page 69
Introduction......Page 88
Enzymes of the prostaglandin biosynthetic pathway......Page 89
PLA2......Page 90
Cyclo-oxygenase (COX)......Page 95
Prostaglandin synthases......Page 99
Prostaglandin dehydrogenase......Page 100
Interleukin-8......Page 101
Oxytocin Receptor......Page 104
Transcription factor activity and the onset of labour......Page 105
Activator protein-1 and nuclear factor kappa B......Page 106
Steroid hormones......Page 108
Inhibition of NF-kappaB in the prevention of preterm delivery?......Page 109
References......Page 110
Description of immaturity......Page 121
Regional versus hospital-specific outcome......Page 122
Time period of study......Page 123
Age at death......Page 124
Racial characteristics......Page 126
Mortality......Page 127
Major disabilities......Page 128
Overall severe disability......Page 129
Blindness......Page 130
Short-term morbidity......Page 131
Chronic lung disease and home oxygen......Page 132
Necrotising enterocolitis and feeding difficulties......Page 133
Chronic respiratory symptoms......Page 134
Cognitive ability......Page 135
Behaviour......Page 136
Growth......Page 138
Summary......Page 139
References......Page 140
Risk scoring......Page 145
Fetal fibronectin......Page 146
Uterine activity monitoring......Page 147
Cervical ultrasound......Page 148
Oestriol......Page 154
Relaxin......Page 155
Inflammatory cytokines......Page 156
Alpha-fetoprotein (AFP)......Page 157
Combining markers to estimate risk of preterm delivery......Page 158
References......Page 159
Introduction......Page 165
Socioeconomic factors......Page 166
Recreational drug abuse......Page 167
Psychological stress......Page 168
Enhanced social support......Page 169
Reproductive disorders......Page 170
Prophylactic tocolysis......Page 172
Cervical therapy......Page 175
Conclusion......Page 176
References......Page 177
Diagnosis of membrane rupture......Page 183
Amniocentesis......Page 184
Ultrasound......Page 185
Prematurity......Page 186
Perinatal brain injury......Page 187
Lung injury......Page 188
pPROM before fetal viability......Page 189
pPROM between 25 and 31 weeks\' gestation......Page 190
Outpatient versus inpatient management......Page 191
Prophylactic antibiotic use and pPROM......Page 192
Treatment of chorioamnionitis......Page 193
Steroids......Page 194
Retention of cervical stitch......Page 195
Mode of delivery......Page 196
References......Page 197
General investigations......Page 203
Fetal Fibronectin......Page 204
Ultrasound measurements of cervical length......Page 205
Risk benefit analysis of immediate versus delayed delivery......Page 206
beta sympathomimetics......Page 207
Oxytocin receptor antagonists......Page 209
Calcium channel blockers......Page 210
Inhibitors of prostaglandin synthesis......Page 211
Magnesium sulphate......Page 212
General measures including transfer......Page 213
Single course......Page 214
Thyrotrophin-releasing hormone......Page 215
Intrapartum fetal monitoring......Page 216
Mode of delivery in the preterm breech......Page 217
References......Page 218
Other reading......Page 221
Aetiology and Incidence......Page 222
Ultrasound......Page 223
Bed rest......Page 224
Tocolysis......Page 225
Investigation and treatment of threatened pre-term labour......Page 226
Intrauterine death......Page 228
Intrauterine transfer......Page 229
Diamniotic; very low birthweight/very preterm; first twin cephalic......Page 230
Triplets and higher-order pregnancies......Page 232
Medical staffing issues......Page 233
Definition and aetiology......Page 234
Gestation up to 34 weeks......Page 235
Magnesium sulphate......Page 236
Definition and aetiology......Page 237
Tocolysis......Page 238
Transfer to a unit with neonatal intensive care facilities......Page 239
Conclusions......Page 240
References......Page 241
Introduction......Page 247
Situations where there is an increased risk of precipitating labour......Page 248
Risk of premature delivery and miscarriage......Page 249
Drug treatment......Page 250
Planned preterm delivery......Page 251
Planned preterm delivery for maternal reasons......Page 252
Cardiac disease......Page 253
Hypertension......Page 254
Cardiac arrest......Page 257
Restrictive lung disease......Page 258
Transplanation......Page 259
Risk factors for preterm delivery......Page 260
Tocolytics......Page 261
Prostaglandin synthetase inhibitors......Page 263
Timely and appropriate provision of analgesia and/or anaesthesia......Page 264
When does the labour become inevitable?......Page 265
What is the ideal analgesic or anaesthetic?......Page 266
References......Page 269
Anticipation......Page 272
Prevention of hypothermia......Page 273
Breathing......Page 277
Intubation versus continuous positive airway pressure (CPAP)......Page 279
Chest compressions......Page 280
Surfactant......Page 281
Sodium bicarbonate......Page 282
Admission and stabilisation on the neonatal unit......Page 283
Surfactant......Page 284
Mechanical ventilation......Page 285
Postnatal steroids......Page 286
Patent ductus arteriosus (PDA)......Page 287
Hypotension......Page 288
Feeding and nutrition......Page 289
Necrotising enterocolitis......Page 290
Transfusion......Page 292
Jaundice in the preterm infant......Page 294
Infection......Page 295
Neurological screening......Page 299
Periventricular leukomalacia......Page 302
Summary......Page 305
The peri-viable neonate......Page 306
Long-term follow-up......Page 307
References......Page 309
Background: the need for change......Page 319
Review Groups......Page 320
Service infrastructure......Page 321
Maternity services......Page 322
Transport services......Page 323
Staffing requirements......Page 324
Effects on postgraduate training and academic infrastructure......Page 325
The way forward......Page 326
Economic evaluation......Page 327
Why are we interested in the economics of preterm delivery?......Page 329
Cost effectiveness of different strategies for managing preterm labour......Page 330
Management of preterm labour......Page 331
Introduction......Page 332
Principles of counselling......Page 333
Labour and delivery......Page 335
Resuscitation of the infant and withdrawal of support......Page 336
References......Page 337
Consent......Page 341
The Management of pregnancy......Page 344
The management of labour and birth......Page 350
Competence......Page 351
Duty of care, standard of care and breach of duty......Page 357
Causation......Page 363
Establishing harm......Page 364
Negligence causing death of a fetus before birth......Page 365
Negligence causing a child to be born injured......Page 366
Liability under the Congential Disabilities (Civil Liability) Act 1976 and wrongful life actions......Page 367
The common law position in Scotland......Page 368
Reform of actions for medical negligence......Page 369
References......Page 371
Cases......Page 373
Introduction......Page 376
General legal principles for treatment......Page 378
Criminal law limitations......Page 380
Best interests, benefits and burdens and quality of life......Page 384
Futile treatment......Page 391
Parental disagreement with professional opinion......Page 392
Professional guidance......Page 394
References......Page 396
Human rights principles......Page 399
Resuscitation at birth......Page 401
Resource allocation......Page 403
Cases......Page 406
Index......Page 409