Preterm

Question 1

Definition

Answer 1

24-27weeks

Can be spontaneous or iatrogenic

Question 2

Complications - fetal

Answer 2

80% of neonatal intensive care occupancy
20% of perinatal mortality
50% of cerebral palsy
Chronic lung disease
Blindness
Major disability

Question 3

Complications - maternal

Answer 3

Infection strongly associated => severe illness
Postnatal endometritis
C-section

Question 4

Risk factors

Answer 4

Previous history
Lower socio-economic class
Extremes of maternal age
Short inter-pregnancy interval
Maternal medical disease (diabetes, renal failure, thyroid)
Pre-eclampsia
IUGR
Male fetus
High haemoglobin
STIs and vaginal infections
Previous cervical surgery
Multiple pregnancy

Question 5

Prevention

Answer 5

Cervical length can predict
Cervical cerclage - sutures
Progesterone suppositories
Screening and treating UTIs, STIs and BV
Fetal reduction of higher order multiples
Treatment of polyhydramnios - needle aspiration or NSAIDs
Treatment of medical disease

Question 6

Clinical features

Answer 6

Painful contractions
Painless dilatation
Dull suprapubic ache
Increased discharge
Antepartum haemorrhage
ROM
Fever
Descended fetus

Question 7

Management

Answer 7

Steroids <34w
Tocolysis: nifedipine or atosiban (oxytocin-receptor antagonist) can be given to allow time for steroids to be administered. Should not be used for more than 24 hours
Treat infection or placental abruption
In utero transfer to unit with neonatal intensive care facilities
Vaginal delivery