Prematurity and PPROM

Question 1

When are steroids required

Answer 1

Any C section if 24-36 weeks

Elective C section between 37-39 weeks if not had any labour pains

Question 2

Risks of prematurity

Answer 2

RDS
Bronchopulmonary dysplasia from ventilator use
Jaundice
ICH causing cerebral palsy or learning difficulties 
Hypothermia
Immature GI tract requiring TPN
Necrotising enterocolitis
Patent ductus arteriosus
Anaemia
Retinopathy

Question 3

What is PPROM

Answer 3

Preterm prelabour rupture of membranes at less than 37 weeks gestation

Question 4

Fetal risks of PPROM

Answer 4

Intrauterine infection
Cord prolapse 
Placental abruption 
RDS
Cerebral palsy

Question 5

Maternal risks of PPROM

Answer 5

Sepsis

Retained placenta and PPH

Question 6

Management of PPROM

Answer 6

Admit
Erythromycin 250mg QDS for 10 days or until labour starts to increase latency
x2 maternal glucocorticoid steroids
Don’t use any tocolytic drugs (high infection risk)
Monitor with CTG
Monitor mother for infection

Question 7

When to deliver PPROM

Answer 7

At 34 weeks since risk of infection greater than risk of prematurity

Question 8

Management of preterm labour with intact membranes

Answer 8

Admit
Tocolytics e.g nifedipine (Ca channel blocker) and terbutaline (b2-adrenoreceptor agonist)
Maternal glucocorticoid

Question 9

Risk factors for PROM

Answer 9

Amniocentesis
Multiple pregnancy
Cervical incompetence
Placental abruption

Question 10

How to test IGF-1

Answer 10

Actim partus test

Question 11

Maternal symptoms of chorioamnionitis

Answer 11

Pyrexia
Tachycardia
Yellow/brown discharge