Premature (preterm) labour - causes, signs, symptoms, diagnosis and treatment Signs of prematurity and clinical management of preterm labour.

Question 1

when is birth preterm

Answer 1

before 37 completed weeks

Question 2

when is birth very preterm

Answer 2

before 32 weeks

Question 3

when is birth Extremely Preterm

Answer 3

before 28 weeks

Question 4

RF for preterm delivery

Answer 4

High risk factors
History of preterm birth
Cervical insufficiency
Multiple gestation

Previous preterm delivery: below 18/ over 40

Second-trimester abortions: medical/ maternal complications

Uterine causes:
Myoma (submucosal/ subplacental), uterine septum, bicornuate uterus

Abnormal placentation

Infectious causes: Chorioamnionitis, Bacterial vaginosis ,Asymptomatic bacteriuria, Acute pyelonephritis

Fetal causes: Intrauterine fetal death, Intrauterine growth retardation
Congenital anomalies

Question 5

causes of Previous preterm delivery

Answer 5

Low socioeconomic status

Maternal age
below 18 years or above 40 years

Question 6

causes of Second-trimester abortions

Answer 6

Maternal complications (medical or obstetric)

Lack of prenatal care

Question 7

Uterine causes increasing risk of preterm birth

Answer 7

Myoma
(particularly
submucosal or subplacental)

Uterine septum

Bicornuate uterus

Question 8

causes of Abnormal placentation

Answer 8

• Placenta previa

- Ablatio/Abruptio placentae

Question 9

causes of Infectious

Answer 9

– Chorioamnionitis
– Bacterial vaginosis
– Asymptomatic bacteriuria
– Acute pyelonephritis
– Cervical/vaginal colonization

Question 10

Fetal causes of preterm birth

Answer 10

– Intrauterine fetal death
– Intrauterine growth retardation
– Congenital anomalies

Question 11

what is Ablatio/Abruptio placentae

Answer 11

premature separation of the placenta from the uterus. Patients with abruptio placentae, also called placental abruption, typically present with bleeding, uterine contractions, and fetal distress.

Question 12

Diagnosis of preterm labour

Answer 12

Documented uterine contractions
o 4 x 20 mins
o 8 x 60 mins

Documented cervical change
o Cervical effacement of 80%
o Cervical dilation over 2cm+

o History of fluid leakage from vagina,
o Observe amniotic fluid using speculum
o Nitrazin test – alkaline amniotic fluid turns paper yellow >blue (positive) o Fern test – observing dried vaginal fluid under microscope,
o Nile blue test

Question 13

Tests to dg preterm labour

Answer 13

o Nitrazin test – alkaline amniotic fluid turns paper yellow >blue (positive)

o Fern test – observing dried vaginal fluid under microscope,

o Nile blue test

Question 14

Stages of preterm delivery

Answer 14

Partus praematurus imminens

Partus praematurus
incipiens

Partus praematurus progrediens

Question 15

what occurs in Partus praematurus imminens

Answer 15

a. Unregular uterine contractions
b. Cervical canal is close
c. Tocolitic therapy, Corticosteroids therapy, Antibiotic therapy

Question 16

what occurs in Partus praematurus incipiens

Answer 16

a. Regular uterine contractions
b. Cervical change (cervical effacement of 80% or cervical dilatation)
c. Tocolitic therapy, Corticosteroids therapy, Antibiotic therapy

Question 17

what occurs in Partus praematurus progrediens

Answer 17

a. Regular uterine contractions
b. Cervical change (cervical effacement of 80% or cervical dilatation of 2cm or more)
c. PROM
d. Corticosteroids therapy, Antibiotic therapy

Question 18

managment for 1st and 2nd stages of preterm delivery

Answer 18

place patient on NST to confirm uterine activity

Assess cervical status, progress of labour and presenting part.

Vaginal swab for bacteria vaginosis and B streptococcus and give antibiotic

Hydration

Question 19

what is NST

Answer 19

non stress test

baby’s heart rate is monitored to see how it responds to the baby’s
movements.

Question 20

what does NST involve

Answer 20

attaching one belt to the mother’s abdomen to measure

fetal heart rate, and another belt to measure contractions

Question 21

two types of rx for preterm delivery

Answer 21

tocolytic therapy

CorticoSteroid therapy

Question 22

what does tocolytic therapy consist of

inhibition of calcium to prevent uterine contraction

Answer 22

Magnesium sulfate
-intracellular calcium antag

Terbutaline

• b2 agonist
• sympathomimetic decreasing intracellular calcium ions
• inhibits myosin actin interxn

nifedipine(Procardia)
CCB

Question 23

which tocolytic drug is 1st choice for initiation

Answer 23

Magnesium sulfate

Question 24

CS therapy

Answer 24

Dexamethasone and betamethason

Question 25

how do corticosteriods aid preterm labour

Answer 25

Stimulate pneumocyte 2 cell to produce surfactant

- 28 and 34 weeks of gestation.

Question 26

Terbutaline CI and side effects

Answer 26

Ci: DB mellitus & hyperthyroidism

Side effects: tachycardia, palpitations, SOB

Question 27

MgSulfate CI and side effects

Answer 27

CI : myasthenia gravis, Renal failure

side effects: flushing and respiratory arrest

Question 28

CCB (nifedipine) CI and side effects

Answer 28

CI.

side effects: headache, flushing, hypotension

Question 29

What is PROM

Answer 29

premature rupture of the membrane

 Spontaneous rupture of membrane, Amniorrhexis <37weeks

Question 30

Causes of PROM

Answer 30

Infection,
increased intra-uterine pressure (multiple, hydraminios),
abnormal fetal position,
trauma, intercourse,
smoking, previous PROM, short cervix, bleeding,

Question 31

Dg of PROM

Answer 31

History of fluid leakage from vagina,
o Observe amniotic fluid using speculum
o Nitrazin test – alkaline amniotic fluid turns paper yellow >blue (positive) o Fern test – observing dried vaginal fluid under microscope,
o Nile blue test

Question 32

PROM management

Answer 32

B4 34 wks: CS, abiotics, amniocentesis, manage till 34wks

34-36 wks: IOL & antibiotics, magnesium sulfate- neuro protective