Pre Term Labor

Question 1

Risk fators of PTL

Answer 1

Previous of preterm labor or late misscariage
Teenager
Advanced maternal age
1st pregnancy
Cervical surgery
Uterine anomaly
Medical conditions: (renal disease PET, IUGR)
Low ses
Multiple pregnancy

Question 2

Causes

Answer 2

Cervical weakness (hx of surgery)
Infection of the fetal membrane or chorioamnitis (before 32)
Bacerial vaginosis (PPROM and PTL)
Multiple pregnancy
Uterine müllerian anomalies
Hemorrhage (APH or abruptio p)

Question 3

Investigations:

Answer 3

FBC CRP
MSU and swap
USS (to check presentation and fetal weight)
Fetal fibronectin & transvaginal USS

Question 4

If the transvaginal cervical length scan is …. or febronectin assay is …, the labor is unlikely to occur:

Answer 4

> 15mm
-ve

Question 5

Why do we use glucocorticoids in case of PTL

Answer 5

To help in fetal lung maturation so that the incidence of RDS, IVH, and NEC are minimized

Question 6

Steroid of choice

Answer 6

Betamethasone

Question 7

What is tocolytics, and what they used for

Answer 7

They are medications used to delay preterm labor for a short time (48h)
To allow time for steroid administration and/or inutero transfer

Question 8

Examples of tocolytics :

Answer 8

CCB (nifedipine)
Oxytocin receptor antagonist (atosiban)
Mg sulfate (neuroprotection)
B2 agonist
NSAID
Progestrone

Question 9

Prevention of PTL

Answer 9

Treatment of bacterial vaginosis
Progestrone(no effective in multiple pregnancy)
Cervical sutures (cerclage) : effective in cases of cervical weakness or short cervix, and not effective in multiple pregnancy
Cervical pessary
Reduction of pregnancy number ☠️

Question 10

Prediction of preterm labor:

Answer 10

Post obstetric history: previous PTL ++ the risk 4 times
Transvaginal USS of cervix:
Fetal fibronectin (FFN): in +ve more likely to deliver within 7-10 days of testing.