Preterm Labour

Question 1

What is the difference between labour and delivery?

Answer 1

“Labour” refers to the process of childbirth, beginning with the onset of contractions that lead to the opening of the cervix and culminating in the birth of the baby. “Delivery” specifically refers to the moment when the baby is born and is separated from the mother’s body, usually through the vaginal canal or via a surgical procedure like a cesarean section. In summary, labour encompasses the entire process of childbirth, whereas delivery specifically refers to the moment of the baby’s birth.

Question 2

The most Common causes of postpartum hemorrhage can be lumped into 4 groups

Question 3

Causes of preterm labour

Answer 3

1-cervical weakness
2- infection
3-uterine overdistension
4- mullerian anomalies
5- hemmorrhage
6-stress
7- intercurrent illness

Question 4

Risk factor for cervical weakness

Answer 4

1-history of cervical surgery
2- short cervical length

Question 5

Infection of the fatal membranes is called

Answer 5

Chorioamnionitis

Question 6

Causes of chorioamnionitis

Answer 6

1- ascending infection
2- transplacental route
3-invasive procedures

Question 7

Causes of uterine over-distension

Answer 7

1-polyhydramnios
2- multiple pregnancy

Question 8

Why overdistension of uterus initiate labour

Answer 8

Myometrial stretch has been shown to result in up-regulation of oxytocin receptors and pg production

Question 9

Why stretch of fatal membranes initiate Labour

Answer 9

Due to production of pg and cytokines

Question 10

Why illness of the mother due to appendicitis or pyelonephritis or pneumonia, are associated with preterm labour?

Answer 10

The cause either direct, when infection spread directly into the uterine cavity, or indirect when the chemical triggers such as endotoxins or cytokines cause the problem

Question 11

Acute bleeding effect on myometrium

Answer 11

Released Thrombin directly stimulates myometrial contractions

Question 12

Why subchorionic hematoma increase the risk of PPROM

Answer 12

Either through the effect of
Thrombin on membranes strength or through the occurrence of infection in the hematoma

Question 13

Prematurity is common among women reporting increased stress or anxiety

Answer 13

The biochemical pathway is unclear but it may involve increased circulating levels of CRT

Question 14

Main problems with preterm babies

Answer 14

1- respiratory distress syndrome
2- chronic lung disease
3- patent ductus arteriosus
4-jaundice
5-parenchyma cerebral hemmorrhage
6- infection
7- hypoglycemia

Question 15

Preterm labour is of 2 types

Answer 15

1-real (with cervical changes)
2-threatened ( no cervical changes)

Question 16

70% of women with threatened preterm labour will not deliver during current admission, 50% of them will not deliver until birth

Answer 16

Ok

Question 17

Fibronectin assay

Answer 17

This test measure the presence of fibronectin in Vaginal secretions coming from amniotic fluid

Question 18

Benefits of antenatal steroids in preterm labour

Answer 18

Reduce the risk o
1- respiratory distress
2- intraventricular hemmerrhage
3- neonatal death

Question 19

Why tocolytics are used?

Answer 19

To delay delivery long enough for corticosteroids administration to improve neonatal lung function

Question 20

Role of magnesium sulphate

Answer 20

Neuroprotection

Question 21

Which group of patients have to have steroids therapy?

Answer 21

1 - antepartum hemmorrhage
2- preterm rupture of membranes
3- threatened preterm labour
4- growth restriction
5 - chorioamnionitis
6- any condition requiring elective preterm delivery

Question 22

Which steroids used in preterm

Answer 22

Betamethasone
Dexamethasone

Question 23

Repeated courses of corticosteroids are not recommended in pregnant women

Answer 23

Due to the risk of developing side effects in both baby and mother

Question 24

Contraindication of tocolytics

Answer 24

1- placental abruption
2- cervical dilation
3- severe pre-eclampsia
4-intrauterine infection

Question 25

Oxytocin receptor antagonist

Answer 25

Atosiban

Question 26

NSAIDs, used in preterm

Answer 26

Indomethacin

Question 27

Adverse effects of Indomethacin

Answer 27

1- premature closure of ductus arteriosus
2-intraventricular hemmerrhage
3- neonatal renal insufficiency ( Oligohydramnios)
4- necrotising enterocolitis