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Part 2 exam > Preterm labour > Flashcards

Preterm labour Flashcards

1
Q

Risk of cerebral palsy with preterm birth 22-27 weeks

A

14.6%

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2
Q

Risk of cerebral palsy with preterm birth 28-31 weeks

A

6.2%

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3
Q

Risk of cerebral palsy with preterm birth 32-36+6 weeks

A

0.7%

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4
Q

Risk of cerebral palsy with preterm birth at term

A

0.1%

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5
Q

What is the risk of preterm birth in a future pregnancy after one preterm birth?

A

15-20%

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6
Q

What is the risk of preterm birth in a future pregnancy after 2 preterm births?

A

35-40%

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7
Q

What are the modifiable epidemiological risk factors for spontaneous preterm birth?

A

Low BMI, interpregnancy interval of <1year, smoking

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8
Q

What are the non-modifiable epidemiological risk factors for spontaneous preterm birth?

A

Teenage multiparous or advanced maternal age, nulliparity/multiparity, low socioeconomic status, unemployment, low education, minority ethnicity

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9
Q

What are the aetiological factors that may contribute to spontaneous preterm birth?

A

1) Inflammatory: Subclinical local infection or systemic infection/intercurrent illness
2) Uterine overdistension (polyhydramnios/multiple pregnancy)
3) Vascular (abruption)
4) Uterine abnormality (unicornate)
5) Cervical incompetence (history of previous surgical surgery)

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10
Q

What is the maximum timeframe that patients will benefit from steroid injections when administered for suspected preterm delivery?

A

24 hours to 7 days after the second dose

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11
Q

Incidence of preterm birth in the UK (before 37 weeks)

A

8 in 100 babies

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12
Q

Nice guidance [NG25] - what history and investigations would indicate recommendation of either vaginal progesterone or prophylactic cerclage?

A

History = spontaneous preterm birth <34 weeks or late pregnancy loss >16 weeks
AND
Investigation = cervical length <25mm on TVUSS between 16-24 weeks

If the patient only has either the history OR the investigation finding then NICE recommends vaginal progesterone instead of cerclage

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13
Q

NICE guidance [NG25] - what investigation finding would prompt you to consider offering cervical cerclage in a patient with previous history of PPROM or cervical trauma?

A

TVUSS showing cervical length <25mm between 16-24 weeks

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14
Q

At what gestation is cervical length of <25mm an indication for offering prophylactic treatment for preventing preterm labour?

A

16-24 weeks

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15
Q

If a patient is started on vaginal progesterone, how long dose NICE recommend continuing it?

A

Start between 16-24 weeks and continue until at least 34 weeks (this is off licence)

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16
Q

NICE guidance [NG25] - management of incidental finding of cervical length <25mm between 16-24 weeks but no history of late miscarriage, preterm birth, previous PPROM or cervical trauma

A

Offer vaginal progesterone from 16-24 weeks until at least 34 weeks (this is off licence use)

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17
Q

What protein is detected by a ROM test?

A

Placental alpha microglobulin 1 (PAMG-1)

18
Q

NICE guidance [NG25] - which antibiotic course is recommended for confirmed spontaneous PPROM in a patient not in labour?

A

Erythromycin 250mg QDS for maximum of 10 days

19
Q

NICE guidance [NG25] - when is rescue cerclage contraindicated?

A

Bleeding, infection, Contractions

20
Q

NICE guidance [NG25] - when do NICE recommend that a rescue cerclage can be considered

A

Dilated cervix, unruptured membranes at 16-27+6/40

21
Q

What are the contraindications for a fetal fibronectin swab?

A

Bleeding, SROM, lubricating gel, digital examination, sexual intercourse in last 24 hours, gestation <24 and >34 weeks, >3cm dilated

22
Q

NICE guidance [NG25] - which tests do NICE recommend for a woman suspected of preterm labour >30/40 gestation?

A

TVUSS OR FFN
TVUSS - if cervix <15mm treat as TPTL
FFN if positive >50ng/ml treat as TPTL

23
Q

What are the contraindications to tocolysis?

A

bleeding and infection

24
Q

What does NICE recommend as first line tocolytic agent?

A

Nifedipine ( this is an off label use)

25
Q

NICE guidance [NG25] - which gestation does NICE recommend tocolysis should be “considered” and when do they recommend it should be “offered”?

A

Considered- Threatened preterm labour 24-25+6/40

Offered - Threatened preterm labour 26-33+6/40

26
Q

NICE guidance [NG25] - Which gestation dose NICE recommend corticosteroids should be “offered” and when do they recommend they should be “considered”?

A

“offered” - suspected del within 48 hours 24-33+6/40

“considered”- suspected del within 48 hours 34+0-35+6/40

27
Q

NICE guidance [NG25] - which gestation does NICE recommend MgSO4 should be “offered” for neuroprotection and when do they recommend it should be “considered”?

A

Offer - 24-29+6

Consider- 30-33+6/40

28
Q

NICE guidance [NG25] - which gestation does NICE recommend avoiding an FSE?

A

Below 34/40

29
Q

NICE guidance [NG25] - which gestation does NICE recommend avoiding FBS?

A

Below 34/40

30
Q

NICE guidance [NG25] - in what circumstance does NICE recommend considering c-section in PPROM or Preterm delivery?

A

Breech 26-36+6/40

31
Q

What is the rate of survival for babies with extreme prematurity?

A

53% 22-26 weeks gestation

32
Q

Overall incidence of preterm labour in the UK

A

5-10%

33
Q

How often does infection cause preterm labour?

A

20-40% of cases

34
Q

If a woman has had previous cervical surgery, what factors would prompt cervical length measurements by TVUSS in pregnancy?

A

LLETZ with a depth of >20mm

TWO or more LLETZ procedures

35
Q

How are cervical length measurements performed?

A

TVUSS, empty bladder, sagittal view from internal os to external os, if funneling from the function internal os to the external os

36
Q

What is the sensitivity and specificity of cervical length screening in patients with a history of previous preterm labour?

A

60% if performed in a singleton pregnancy

37
Q

NICE guidance [NG25] - which gestation does NICE recommend cervical length by TVuss (if available) for patients presenting in TPTL?

A

TPTL after 30/40 - if <15mm NICE recommends offering steroids and tocolysis

38
Q

What does cochrane say about the treatment of asymptomatic BV and bacteriuria and its impact on preterm birth?

A

Cochrane reviews found no decrease in preterm birth from treatment of bacterial vaginosis or asymptomatic bacteriuria

39
Q

20-24 weeks pregnant, cervical length <25mm but >20mm, what is the risk of preterm delivery?

A

25% before 28 weeks

40
Q

20-24 weeks pregnant, cervical length <20mm, what is the risk of preterm delivery?

A

42% before 32 weeks

62% before 34 weeks

Part 2 exam (39 decks)

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