Pre Term Labour

Question 1

What is a differential for the symptoms of labour?

Answer 1

Urinary tract infection

Question 2

What are the causes of pre term labour

Answer 2

Infection (uti or group B strep)
Maternal pyrexia 
Uterine abnormalities
Cervical incompetence 
Multiple pregnancies 
Fetal abnormalities
Polyhydramnios 
Placenta Praevia or abruptio
IUGR

GPH

Question 3

What are the risk factors?

Answer 3

Poor ses 
Previous pre term labour
Unbooked 
Malnutrition, smoker
Alcohol

Question 4

What is the management of suspected preterm labour?

Answer 4

Establish a diagnosis, ascertain a cause and decide on tocolysis

Question 5

What investigations would you do if a patient came with suspected pre term labour

Answer 5

Midstream urine M C and S
High vaginal swab
CTG
Ultrasound

Question 6

Contraindications to tocolysis

Answer 6

Intrauterine infection
Fetal distress 
IUD 
lethal congenital anomaly
APH 
Pre-eclampsia 
IUGR 
Cervical dilation > 6 cm

Question 7

What is the first drug of choice for tocolysis?

Give the class, dosage and contraindications

Answer 7

Nifedipine (Adalat), calcium channel blocker
Initially 30 mg po stat then 20 mg after 90 mins and if contractions persist, 20 mg every 6 hours

CI: hypovolemia and cardiac conditions

Question 8

What is the drug of choice for tocolysis when transferring a patient and what are its contra indications

Answer 8

Salbutamol

CI: stenotic valvular lesion, shock, diabetes,thyrotoxicosis

Question 9

When are you able to give indomethasin to tocolyse?

Answer 9

Before 33 weeks gestation

Question 10

What is the dosage for betamethasone?

Answer 10

12 mg IM 24 hours apart (2 doses)

Question 11

What are the benefits of betamethasone?

Answer 11

Enhances fetal lung maturity, prevents intraventricular haemorrhage and necrotising enterocolitis

Question 12

What is important for the delivery of a preterm infant?

Answer 12

1. Avoid heavy sedation and analgesia
2. Epidural analgesia is preferable
3. Gentle controlled delivery
4. Episiotomy is not always essential
5. Forceps may be used to control the delivery but is of little value
6. Vacuum should not be used
7. Gentle resus, paedatrician should be available
8. Repeatedly assess whether fetus is in longitudinal lie

Question 13

What are causes of preterm pre labour rupture of membranes?

Answer 13

1) intrauterine infection
2) an incompetent cervix
3) iatrogenic rupture of membranes to induce labor
4) amniocentesis complication
5) external cephalic version complication
6) polydramnios
7) multiple pregnancy

Question 14

How do you confirm a pre term/pre labour rupture of membranes?

Answer 14

• turns red litmus blue
• ferns test
• fetal fat cells turn orange with 1% nile blue sulphate

Question 15

What is the management of preterm rupture of membranes at 35 weeks or over

Answer 15

Expedite delivery after 24 hours of rupture of membranes if not in labour
If patient is HIV positive augment or induce labour after 4 hours of rupture of membranes. All patients should receive IV antibiotics

Question 16

What antibiotics are given to PPROM patients?

Answer 16

Erythromycin or azithromycin

Question 17

What are signs of intra-uterine infections?

Answer 17

Maternal pyrexia 
Uterine tenderness
Fetal tachycardia 
Rising white cell count 
Foul smelling liquor

Question 18

Why are regular ultrasounds important in PPROM?

Answer 18

Assessment of amniotic fluid and fetal growth

Pressure deformities and pulmonary hypoplasia may follow gross oligohydramnios

Question 19

Define preterm labour

Answer 19

Onset of labour before 37 completed weeks gestation.

Labour: regular painful contractions (increasing in strength and frequency) with cervical changes (dilatation and effacement)