preterm labour

Question 1

rupture of membranes

Answer 1

amniotic sac has ruptured

Question 2

spontaneous rupture of membranes

Answer 2

amniotic sac has ruptured spontaneously

Question 3

prelabour rupture of membranes

Answer 3

amniotic sac has ruptured before onset of labour

Question 4

prolonged rupture of membranes

Answer 4

amniotic sac ruptures >18hrs before delivery

Question 5

prematurity

Answer 5

birth < 37wks

Question 6

extreme preterm

Answer 6

< 28wks

Question 7

very preterm

Answer 7

28-32wks

Question 8

mod-late preterm

Answer 8

32-37wks

Question 9

Prophylaxis of Preterm Labour - options

Answer 9

vaginal progesterone

cervical cerlage

Question 10

Prophylaxis of Preterm Labour - vaginal progesterone

Answer 10

progesterone has role in preventing labour by decreasing activity of myometrium and preventing cervical remoddeling

Question 11

Prophylaxis of Preterm Labour - vaginal progesterone - who

Answer 11

women with cervical length < 24mm on vaginal USS between 16-24wks

Question 12

Prophylaxis of Preterm Labour - cervical cerclage

Answer 12

stitch in cervix to add support and keep it closed

stitch removed when woman goes into labour or reaches term

Question 13

Prophylaxis of Preterm Labour - cervical cerclage - who

Answer 13

women with cervical length < 25mm on vaginal USS
16-24wks
previous premature birth of cervical trauma (e.g. colposcopy and biopsy)

Question 14

Prophylaxis of Preterm Labour - rescue cervical cerclage

Answer 14

between 16-27+6 when there is cervical dilation w/o rupture of membranes, to prevent progression and premature delivery

Question 15

Preterm Prelabour Rupture of Membranes

Answer 15

amniotic sac ruptures, releasing amniotic fluid before onset of labour and in preterm pregnancy < 37wks

Question 16

Preterm Prelabour Rupture of Membranes - diagnosis

Answer 16

speculum examination reveals pooling of amniotic fluid in vagina

Question 17

Preterm Prelabour Rupture of Membranes - diagnosis if in doubt

Answer 17

insulin-like growth factor binding protein - high level in amniotic fluid so can test vaginal fluid

placental alpha-microglobin-1

Question 18

Preterm Prelabour Rupture of Membranes - Mx

Answer 18

prophylactic antibiotics

induction of labour from 34wks

Question 19

Preterm Prelabour Rupture of Membranes - prophylactic antibiotics

Answer 19

erythromycin 250g 4x daily for ten days

or until labour is established if within 10 days

Question 20

preterm labour with intact membranes

Answer 20

regular painful contractions and cervical dilation w/o rupture of amniotic sac

Question 21

preterm labour with intact membranes - diagnosis

Answer 21

speculum to asses for dilatation

< 30wks - diagnosis can be made on assessment

> 30wks use transvaginal USS or assess cervical length <15mm confirms diagnosis

Question 22

preterm labour with intact membranes - diagnosis - alternative to USS

Answer 22

fetal fibronectin

<50 is negative result and indicated preterm labour is unlikely

Question 23

preterm labour with intact membranes - Mx

Answer 23

fetal monitoring CTG 
tocolysis w nifedipine
maternal steroids
IV magnesium sulphate
delayed cord clamping

Question 24

tocolysis

Answer 24

medications to stop uterine contractions

1. Nifidepine
2. atosiban

Question 25

tocolysis - when can be used

Answer 25

24 - 33+6 to delay delivery

used as a short term measure - <48hrs

Question 26

magnesium sulphate

Answer 26

giving maternal IV magnesium sulphate helps protect fetal brain during premature delivery

reduces risk cerebral palsy

Question 27

magnesium sulphate - how to use it

Answer 27

give within 24hrs of delivery preterm babies < 34wks

Question 28

magnesium sulphate - maternal monitoring

Answer 28

monitor for signs of toxicity

• reduced RR
• reduced BP
• absent reflexes