Chapter 11: Preterm Labour And Delivery Flashcards
You are a trainee intern in birthing suite with Emma, a 19-year-old G1P0 Pākehā woman, who presents at 31 weeks’ gestation with regular painful uterine activity and backache for three hours. There is no vaginal bleeding and no history suggestive of ruptured membranes. On examination contractions can be palpated. The fetal head is engaging. A sterile speculum shows the cervix is 2-3cm dilated without any vaginal discharge. A CTG is normal and reassuring. The pregnancy has previously been normal and a routine scan at 19 weeks showed no fetal or placental abnormality. Of the following options, which is the most appropriate INITIAL management?
I.V. Co-amoxiclav (Augmentin)
I.M. Magnesium Sulphate
Vaginal reassessment in 4 hours
Tocolytic and corticosteroid therapy
Ultrasound scan
Expectant management
Emergency caesarean section
Discharge home and review at clinic in a week
Tocolytic and corticosteroid therapy
You are a trainee intern in birthing suite with Gina, a 35-year-old G1P0 Pākehā woman who has been transferred to the base hospital at 31 weeks’ gestation because of increasingly painful contractions for the last four hours. She also had a show an hour ago. Her general observations are normal. On abdominal examination her fetus is in longitudinal lie, with a breech presentation. The fundal height is normal for 31 weeks. The CTG shows the presence of regular contractions and the fetal heart monitoring is reassuring. On vaginal examination, the cervix is partially effaced and 2-3cms dilated with the presenting part at station -2. The membranes are intact. Which of the following is the most important immediate management option?
Place Nil By Mouth
Take vaginal swabs
Arrange an ultrasound
Arrange for a caesarean section
Take blood for Group and Hold
Start a tocolytic and steroids
Start a tocolytic and steroids
You are a trainee intern in birthing suite with Clare, a 19-year-old G1P0 Pākehā woman at 31 weeks who presents having had a “show” four hours ago. Clare is aware of uterine tightenings that occur every 10-15 minutes but are painless. She is understandably anxious as six weeks ago her sister had an infant that died prematurely from a “brain haemorrhage and lung problems” after being born at 24 weeks gestation. Clare’s antenatal course has previously been uncomplicated. Routine ultrasound examinations in the first and second trimester were normal. On speculum examination, there is no evidence of the show, and the cervix appears long and closed. Of the following options, which would BEST DETERMINE whether she is at increased risk of premature labour?
Bloods tests for immune and growth factor testing
Blood test for progesterone level
A fetal fibronectin swab
A transabdominal U/S assessment of the cervical length
A cardiotocograph (CTG)
A fetal fibronectin swab
You are a trainee intern in general practice seeing Jackie, a 25-year-old G1P0 Pākehā woman who has recently had a miscarriage at 18 weeks. Because the history was typical of cervical insufficiency, the obstetrician has recommended Jackie have a cervical cerclage procedure at 14 weeks in her next pregnancy. Jackie asks you why the timing of the cerclage would be at 14 weeks. Which of the following options is the correct answer?
It is after the booking antenatal blood tests are known
It is just before any uterine contractions occur
It is after ultrasound has confirmed viability of the fetus
It is after the first trimester genetic screening tests (MSS-1) have confirmed a low-risk result for fetal abnormality
It is just before the cervix starts dilating
It is after the first trimester genetic screening tests (MSS-1) have confirmed a low-risk result for fetal abnormality
You are in birthing suite with Colleen, a 35-year-old primiparous Pākehā woman who is 30 weeks’ gestation. Colleen has been transferred by ambulance from a primary birthing unit to hospital with a 4-hour history of regular painful contractions every 3-4 minutes. Prior to ambulance transfer her cervix was 3 cm dilated and fully effaced. Steroids and tocolytic therapy were commenced at the primary birthing unit after discussion with the O&G registrar. In the ambulance Colleen had a show and she now feels pressure in her buttocks. Colleen is afebrile. On abdominal examination, her fetus is in a longitudinal lie, breech presenting and appears of normal size for 31 weeks. The CTG confirms uterine contractions are occurring every 4 minutes and the fetal heart rate is normal. Of the following options, what is the MOST IMMEDIATE priority?
Place nil by mouth
Arrange an ultrasound
Take vaginal swabs
Assess the cervix for dilatation and the station of the presenting part
Take blood for a Group and Hold
Arrange an urgent MSU
Assess the cervix for dilatation and the station of the presenting part
You are a trainee intern in birthing suite with Dawn, a 35-year-old G2P0 NZ European woman at 31 weeks who has presented to hospital with a 4-hour history of contractions after a show. Dawn conceived spontaneously whilst undergoing fertility investigations. Her antenatal progress until now has been normal. You take a more detailed history. Of the following options, which elements of Dawn’s history is the MOST LIKELY to predispose her to preterm labour?
Two cervical cone biopsies four years ago
An arcuate uterus on an ultrasound scan as part of subfertility investigations
A pedunculated 2cm fibroid arising from the serosa of the fundus of the uterus
Essential hypertension (no medication required)
Previous pregnancy terminated medically at 8 weeks gestation
Two cervical cone biopsies four years ago
You are a trainee intern in delivery suite with Anu, a 24-year-old G1P0 New Zealander of Indian ethnicity who has just been started on tocolytic therapy because of threatened preterm labour at 32 weeks’ gestation. The fetal lie is longitudinal with a cephalic presentation. The cervix is 2cms dilated, and the membranes intact. She has also been given an injection of the corticosteroid, betamethasone, and is to have another in 24 hours. You explain that the steroids are to help mature the baby and reduce the risk of neonatal complications. Anu asks you which organs that steroids effect? Of the following options, which are the three main organs that antenatal steroids affect?
Gut, liver and lung
Pancreas, gut and lung
Lung, brain and gut
Brain, liver and pancreas
Lung, gut and pancreas
Lung, brain and gut
You are a trainee intern in birthing suite with Lin, a 24-year-old G1P0 New Zealander of Chinese ethnicity who has ruptured membranes (PPROM) at 33 weeks’ gestation. She is not contracting. Sterile speculum examination confirms pooling of liquor, but the cervix is closed. You obtain the following in Lin’s history. Which of these is MOST LIKELY to have predisposed her to developing PPROM?
Poor dentition
Cigarette smoking
Symptoms suggestive of a reproductive tract infection (e.g. bacterial vaginosis [BV], trichomoniasis, gonorrhoea)
BMI > 30 kg/m2
Low socio-economic status
Feedback
Symptoms suggestive of a reproductive tract infection (e.g. bacterial vaginosis [BV], trichomoniasis, gonorrhoea)
You are a trainee intern in a rural practice with Ana, a 24-year-old G1P0 Pasifika woman at 29 weeks’ gestation who has presented acutely with ruptured membranes and draining clear liquor. She has soaked a pad in the last hour. Ana is visiting the area and away from her usual LMC midwife. She reports her pregnancy has been uncomplicated, with the last antenatal visit two weeks ago. There has been no bleeding and she is not contracting. Of the following management options, which is the MOST IMMEDIATE?
Arrange transfer to the tertiary obstetric unit which is one hour away
Insert an IV line
Start tocolytic therapy
Administer stat dose of IV hydrocortisone
Start antibiotic therapy with Co-amoxiclav (Augmentin)
Arrange transfer to the tertiary obstetric unit which is one hour away
