Pre-term labour

Question 1

What is pre-term labor?

Answer 1

Labour which occurs prior to 37 weeks of gestation

Question 2

What are the indications for a pre term delivery?

Answer 2

• Pre-eclampsia

- Fetal growth restrictions

Question 3

What are the strategies for pre-term labour (prophylaxis)

Answer 3

• Cervical cerclage (or stitch)
• Bed rest
• prophylactic tocolysis
• Uterine activity monitoring
• Control obstetric problems which necessitate early delivery
• control any vaginal infections

Question 4

What allows us to predict pre term labour? Name 4 modes

Answer 4

• Uterine activity monitoring
• Serial cervical assessment
• Cervicovaginal biochemistry

Question 5

How does infection cause preterm labour?

Answer 5

Infection causes release of inflammatory mediators such as prostaglandin, which affects the uterus and cause it to contract

Question 6

What is the relationship between cervical length and pre-term birth?

Answer 6

As the cervical length decreases, the relative rate of preterm delivery increases.

Question 7

What are the functiy is ons of fetal fibronectin?

Answer 7

• Extracellular matrix protein
• Trophoblast proliferation
• Blastocyst implantation
• Early embryo development
• Cell attachment

Question 8

What is the function of fetal fibronectin?

Answer 8

• found the interface of the chorion and the decidua (b/n the fetal sac and the uterine lining). It is thought to be an adhesive or biological glue, which binds the fetal sac to the uterine lining. It will leak through to the vagina in pre-term delivery is unlikely to occur. It is a screening test for pre-term delivery.

Question 9

Which anatomical area is the vaginal swab taken from?

Answer 9

• Swab is taken from the posterior vaginal fornix, the bedside kit is used to analyse fibronectin.

Question 10

Name some tocolytic agents?

Answer 10

• beta adrenergics: ritodine, salbutamol, terbuatline
• magnesium sulfate
• Prostaglandin inhiitors: indomethacin
• Calcium anataognist - nifedipine

Question 11

In terms of preparing the fetus for pre term birth, what can be given to prevent respiratory distress syndrome?

Answer 11

• Needs to be transferred to a suitably equipped perinatal facility
• Corticosteroids are to be given to help mature the fetal lungs (beta-methasone)

Question 12

What is given for neuroprotection for preterm birth?

Answer 12

Magnesium- sulfate

- At less than 30 weeks, as close to 4 hours before birth as possible or atleast within 24 hours of expected birth

Question 13

Preterm premature rupture of membranes?

Answer 13

Preterm premature rupture of membranes (PPROM) is the spontaneous prelabour rupture of membranes before the onset of labour, prior to 37 weeks of gestation.

Question 14

What is cervical insufficiency?

Answer 14

Cervical insufficiency is the painless dilatation of the cervix which results in the recurrent second trimester pregnancy losses. Cervical insufficiency may be caused by structural weakness of the cervix. Other risk factors include collagen abnormalities ( e.g. ehlers Danlos syndrome) and uterine abnormalities. Acquired risk factors include obstetric trauma to the cervix or treatments for cervical for cervical dysplasia such as a cone biopsy of the cervix.