Preterm Labour

Question 1

What is preterm labour?

Answer 1

Labour that begins after 20 weeks gestation and before 37 weeks gestation

Question 2

Risk factors of preterm labour?

Answer 2

• Previous history of preterm labour
• Low SES score
• Smoking/Drug use
• Cervical insufficiency
• Multiple pregnancy
• Young

Question 3

Below what gestation is there an increased chance of neonatal death?

Answer 3

<34 weeks

Question 4

Below what gestation should resuscitation not be attempted on a newborn?

Answer 4

<24 weeks

Question 5

What are the causes of spontaneous preterm labour?

Answer 5

• Thrombin (recurrent PV bleeding in first and second trimester, antepartum haemorrhage)
• Cervical insufficiency (LLETZ, Cone biopsy, ERPC)
• Stretch receptors (multiple pregnancy, polyhydraminos, fibroids)
• Lifestyle factors (smoking, drug use, low ses, young, domestic violence, low maternal weight)
• Infection (chlamydia, urinary tract infection, bacterial vaginosis, periodontal disease)

Question 6

Causes of preterm labour identified in pregnancy?

Answer 6

• Placental abruption
• Placental Previa
• Bicarbonate uterus
• Multiple pregnancy
• Cervical insufficiency
• Polyhydramnios
• Infections
• Anaemia
• Premature rupture of membranes
• Iatrogenic
• Fetal anomalies

Question 7

Signs of preterm labour?

Answer 7

• Abdominal cramping
• Lower back pain
• Increased vaginal discharge
• Dull, lower back pain
• Suprapubic pressure
• Urinating frequently
• Diarrhoea

Question 8

Tests undertaken to diagnose preterm labour

Answer 8

• Speculum examination
• Fetal fibronection

Question 9

What is contraindicated with a speculum examination in suspected preterm labour?

Answer 9

• Use water only, swabs, VE, lubricant gel can interfere with fetal fibronectin results

Question 10

What is fetal fibronectin test?

Answer 10

A test that measures fetal fribrotecin protein that is produced by the foetus that functions at the biological glue that holds the placenta to the uterine well. This test estimates how likely it is that a woman will go into labour within the next seven days.

Question 11

What does a positive fetal fibronection test mean?

Answer 11

Fibronection >200ng/mL is a positive result which means there is an increased likelihood of the woman going into labour in the next seven days. Positive results are not very accurate, negative results are.

Question 12

When is a fetal fibronectin test contraindicated?

Answer 12

• Sexual intercourse within 24 hours
• Rupture of membranes
• Vaginal examination within 24 hours
• Lube used within 24 hours
• Current vaginal bleeding
• Transvaginal ultrasound in last 24 hours

Question 13

What is the medical management of a women in preterm labour

Answer 13

• Consider tocolytics
• Consider corticosteroids
• Consider magnesium sulphate
• All decided by obstetrics

Question 14

What is a tocolytic?

Answer 14

Tocolytics are used to slow down labour in women who are <34+6 weeks gestation to allow more time for corticosteroids to be administered

Question 15

A common tocolytic is nifedipine, how does this work and when are the doses given?

Answer 15

Nifedipine relaxes the smooth muscles and is 2 doses given 24 hours apart

Question 16

What are the contraindications for nifidepine?

Answer 16

Hypotension and suspected uterine infection

Question 17

What is the midwifery care for administration of tocolytics?

Answer 17

• Monitor maternal blood pressure in the first hour at the time of administration, after 30 minutes and after 60 minutes.
• Monitor maternal BP, pulse, and temperature hourly
• Ensure baseline ctg is normal prior to administration of tocolytic, keep ctg on at administration for first hour and until painful contractions cease

Question 18

What a corticosteroids?

Answer 18

They are used to quickly develop the fetal lungs by increasing surfactant production to enable inflation of the lungs with less resistance in women that are >24 weeks to <34+6 gestation

Question 19

What is the most common corticosteroid used in preterm labour, what is its dosing regime and what are its contraindications?

Answer 19

Betamethasome is the most common corticosteroid. 2 doses should be given 24 hours apart and is contraindicated in women with diabetes as it can affect blood sugar levels

Question 20

What is magnesium sulphate used for?

Answer 20

Used for neuroprotection to help prevent cerebral palsy and other neurodevelopment outcomes in women >24 weeks and <30 weeks gestation in preterm labour

Question 21

Signs of magnesium sulphate toxicity?

Answer 21

Respiratory depression, respiratory arrest, cardiac arrest and death