Management of Preterm Labour

Question 1

definition of preterm labour in terms of GA and cervical dilation and effacement

Answer 1

uterine contractions and cervical changes <37wk GA, usually cervix is at least 3cm dilated+/- effacement

Question 2

Etiology and Risk factors for preterm labour

Answer 2

Etiology: spontaneous, PPROM, maternal/fetal indications, multiples (55% are preterm) Risk factors: previous PTB/PPROM, antenatal bleed, multifetal preg, IVF, advanced maternal age, smoking/drugs, low SES, infections (esp UTI), chronic medical condition, uterine/cervical abnormalities

Question 3

3 key investigations to determine preterm labour

Answer 3

• Physical Exam of vagina for dilation/effacement
• Fetal fibronectin swab: high NPV. Will be positive after intercourse of vaginal exam–> assess PPROM
• Cervical length US: shorter cervix can predict risk of pre-term birth (>30mm means spontaneous PTL is unlikely)

Question 4

3 key meds to prepare the fetus for early delivery

Answer 4

1. betamethasone for 24-34wk GA. ¯ risk of resp distress syndrome,
   intraventricular hemorrhage, necrotizing enterocolitis, ¯ perinatal death. Another option is
   dexamethasone § Contractions: sepsis, active TB, DM (àhyperglycemia)
2. mag sulphate for neuroprotection
3. GBS prophylaxis

Question 5

role of tocolysis and management of preterm labour

Answer 5

inhibits acute preterm labour to hopefully buy time to complete steroids and transfer the mother to a tertiary care center.

• include nifedipine, indomethacin (NSAID)

Question 6

contraindications to tocolysis

Answer 6

intrauterine fetal demise, abnomrla FHR, maternal instability, hemorrhage, intraamniotic infection, medical contracindication to drug , PPROM

Question 7

complications to tocolysis

Answer 7

growth, hypoglycemia/feeding, respiratory, infection, brain hemorrahge, cerebral palsy, cognitive impairment ,developmental delay, blindness, deafness, death

Question 8

management of cervical insufficiency

Answer 8

rescue cerclage, prophylactic cerclage, pessary, progesterone

Question 9

Prevention of PPROM and Preterm Birth

Answer 9

General population: decrease multifetal pregnancies, smoking cessation, optimize medical pre-existing conditions, treat asymptomatic bacteriuria

If they have PTB risk factors: screen for BV, STIs, urine culture, progesterone, US cervical length assessment

Question 10

definition of premature rupture of membranes

Answer 10

Pr emature Rupture of Membranes Definition: rupture of membranes prior to onset of contractions. PPROM Definition: rupture of membranes <37wk GA Etiology: bacterial invasion

Question 11

3 investigations to see if someone has PPROM

Answer 11

1. nitrazine swab when exposed to amniotic fluid. SEmen can cause a false positive
2. speculum
3. leopolds

Question 12

management of PPROM at 24-32 weeks

Answer 12

• antibiotic to increase latency in PPROM. ampicillin +erythromycin for non-labour, and if labouring: Pen G
• betamethasone
• consider US
• transfer +/- tocolysis