Pre Term Labour

Question 1

Macrosomia

Answer 1

Post term pregnancy
Twins pregnancy
Diabetes
Obesity
Male sex
Multiparty

Question 2

In vitro fertilisation

Answer 2

Fresh cycle EDD =LMP-13 / Day of retrieval +266
Frozen cycle
Day 3 of transfer EDD= Date of transfer - 16/ Day of retrieval + 263
Day 5 of transfer EDD = Date of transfer - 18 / Day of retrieval + 261

Question 3

Pre term labour

Answer 3

Uterine contraction = more than equal to 4 in 20 mins
OR
more than equal to 8 in 60 mins
+
Cx dilation- more than equal to 3 cms
Cx length - less than equal to 2cms
Fibronectin present - more than equal to 50ng/ml in cervico vagina swab (increase in IL-6 IL8 TNF alpha)

Question 4

Indication for cervical cerclage

Answer 4

Done in pregnant female less than equal to 24 weeks
previous history of pre-term birth + length of cervix on TVS less than equal to 2.5 cm + singleton pregnancy

Question 5

Predicting pre term labour
Diagnosis of pre-term labour

Answer 5

Cervical length less than equal to 2.5 cm with no contractions
Cervical length less than equal to 2 cm plus uterine contractions

Question 6

Placental aromatase deficiency

Answer 6

Decrease estrogen leading to post term pregnancy
Increase androgens leading to hirsutism previous and ambiguous genitalia in female fetus

Placental aromatase is required for conversion of DHEAS to oestrogen

Question 7

Tocolytics of choice in India
Less than 32 weeks
32 to 34 weeks
Tocolytic of choice in heart disease patient
Tocolytic contraindicated in diabetes

Answer 7

1-Nifedipine
2-indomethacin
3-NIFEDIPINE
4-atosiban
5- beta agonist

(Indomethacin given more than two weeks can cause oligohydroamnios and if given after 32 weeks can cause premature closure of PDA)

Question 8

PROM
PPROM

Answer 8

Rupture of membrane more than Equal to 37 weeks, but before induction of labour
Rupture of less than equal to 37 weeks (pre-term premature rupture of membrane)

Question 9

Tests for premature rupture of membrane

Answer 9

1. Nitrazine paper test
2. Fern test
   LAB TEST
3. Actin test-detect protein IGF binding protein/plasma protein 12
4. Amnisure - detect PAM-G1 protein

Question 10

Chorioamnionitis diagnostic criteria
Not a diagnostic criteria

Answer 10

 Temperature more than equal to 39°C on one occasion or more than equal to 38°C on two occasions half an hour apart
Plus anyone of the following
1. Fetal heart rate more than 160 bpm.
2. Maternal WBC count more than equal to 15,000.
3. Purulent discharge from os

Maternal tachycardia and uterine tenderness
(C-section is not preferred, can lead to postpartum endometritis)

Question 11

Amniotic fluid
Specific gravity
Osmolality
P H
Colour
Maximum volume
At term /40 weeks
At more than equal to 42 weeks
Hormones present

Answer 11

1.1.008 to 1.010
2. 260 Milli Osmo per litre.
3. 7-7.5
4-colourless at term straw or turbid colour
5. 32 to 34 weeks - 1 L
6. 800 ML.
7. 200 ML.
8. Insulin prolactin renine

Question 12

Abnormal colours of amniotic fluid
Green
Golden
Tobacco juice
Saffron or yellowish green
Dark coloured

Answer 12

1. Meconiom present (fetal distress, breech or transverse lie, listeria infection)
2. RH incompatibility.
3. Intra uterine death.
4. Post term pregnancy.
5. Concealed haemorrhage.

Question 13

Potter syndrome

Answer 13

Renal ageNesis
Severe oligo hydroamnios
Flat faces
Lung hypoplasia
(indication for MTP)

Question 14

Indication for amnioinfusion

Answer 14

Oligo plus membrane are intact plus on CTG, continuous variable deceleration
(With normal saline)

Question 15

Amniocentesis

Answer 15

2 to 2.5L at thousand ML in 20 minutes is taken out
Most common complication is pre-term labour
Done until 34 weeks

Question 16

Measurement of amniotic fluid
Severe polyhydramnios

Answer 16

Two parameters
1. Amniotic fluid index.
Normal value - 5-24 cm
2. Single largest vertical pocket.
Normal value 2-8 cm

Amniotic fluid index more than 35 cm
Single largest vertical pocket more than 16 cm