14) Premature (Pre-term) Labor - Causes, CFs, Dx, Tx. Signs of Prematurity. Premature Rupture of Amniotic Membranes

Question 1

What is the Definition of “Preterm Labor”?

Answer 1

• Birth between 20th - 36th Gestational Week
• It’s the Premature Rupture of Amniotic Membranes

WHO Categories

• Extreme = BEFORE 28 Weeks
• Very = 28 - 32 Weeks
• Moderate to Late = 32- 37 Weeks

Question 2

What are the Types of Preterm Delivery?

Answer 2

1) Spontaneous = With intact AM

2) Premature Rupture of Amniotic Membrane

3) Medically Induced = Due to Maternal or Fetal Factors

Question 3

What are the Maternal & Fetal Factors for Medically-Induced Preterm Delivery?

Answer 3

MATERNAL Factors

• Preeclampsia
• Diabetes Mellitus
• Gestational Diabetes
• Renal Disease
• Osteogenesis Imperfecta

FETAL Factors

• Intrauterine Growth Restriction
• Olygohydraminos
• Macrosomia of Foetus

Question 4

What are the Causes of Preterm Labor?

Answer 4

• History of Preterm Birth
• Younger than 18, or Older than 40
• Cervical insufficiency - painless dilation in 2nd Trimester
• Multiple Gestation
• Preeclampsia, Eclampsia
• Placental Abruption + Previa
• Infections - Vaginal

Question 5

What are the Clinical Features of Preterm Labor?

Answer 5

• Uterine Cramping / Contractions
• Rhythmic Low back pain
• Pelvic Pressure
• Increased Vaginal Discharge
• Vaginal Bleeding

Question 6

How is Preterm Labor Diagnosed?

Answer 6

• Speculum Exam - For Cervicovaginal Infections, Vaginal Bleeding
• Digital Cervical Exam - For Dilation, Effacement + Position
• Fetal Heart Rate & Uterine Activity Monitoring
• Uterine Contractions = 4 within 20min
• Transvaginal US = Shows SHORTER than 25mm Cervical Length

Screening for Bacterial Vaginosis

Question 7

What is the Treatment for Preterm Labor?

Answer 7

• Spasmolytics
• Tocolysis - Magnesium Sulfate
• Calcium Channel Blockers - Nifedipine
• Prophylaxis for Respiratory Distress Syndrome

SIDE EFFECTS of MgS04

• Pulmonary Oedema
• Hypotension
• Muscular Paralysis
• Cardiac Arrest
• Preeclampsia, Chorioamnionitis

Question 8

Explain Premature Rupture of Amniotic Membrane

Answer 8

RISK FACTORS = Vaginal Infection, Smoking, Multiple Pregnancy, Polyhydraminos

DIAGNOSIS = Nitrazine Test for Vaginal pH (4.5 – 6) and Amniotic Fluid pH (7.1 – 7.3)

COMPLICATIONS = Placental Abruption, Puerperal Infection (Pathological), Sepsis, **Neonatal Respiratory Distress Syndrome*

TREATMENT

• Tocolysis - Magnesium Sulfate
• Broad-Spec Abs - For Chorioamnionitis
• Corticosteroids