Preterm labour

Question 1

Preterm birth definition

Answer 1

delivery between 24 - 37 weeks

Question 2

Risk factors for pre term deliivery

Answer 2

1. Previous pre term birth
2. Multiple pregnancy
3. Cervical surgery or uterine abnormalities
4. Pre eclampsiaor IUGR

Question 3

Acute pre term labour

Answer 3

Pre term labour associated with cervical weakness

- early opening of the cervic

Question 4

Presentation of pre term labour

Answer 4

1. Increased vagina discharge
2. Mild lower abdominal pain
3. Bulging membranes on examination

Question 5

Spontaneous rupture of membrane

Answer 5

Spontaneous rupture of the amniotic sack

- common presentation of pre term labour

Question 6

Ix of pre term labour

Answer 6

1. FBC and CRP
2. Ultrasound for fetal presentation
3. Fetal fibronectin assay should be positive

Question 7

Fetal fibronectin

Answer 7

Protein of the amniotic sac

1. Positive - high likelihood of pre term labour

Question 8

Transvaginal cervical length

Answer 8

> 15 mm unlikely to labour

Question 9

Management of preterm labour - DRUGS

Answer 9

1. Steroids Betametasone IM (two doses - 24 hours apart)
2. Tocolysis - nifedipine
   prolongs labour and delivery thus improving gestation

Question 10

Ix of management of preterm labour

Answer 10

1. Transvaginal cervical length scan

2. Fibronectin assay

Question 11

Benefit of giving steroids

Answer 11

1. Reduces rate of respiratory distress, intraventricular hemorrhage and neonatal death

Question 12

Sig of treating bacterial vaginosis

Answer 12

1. Reduce the risk of preterm prelabour rupture of membranes
2. Low birthweight in women with previous preterm birth

Question 13

How is bacterial vaginosis treated

Answer 13

Clindamycin rather than metronidazole

Question 14

Methods of preventing preterm labour

Answer 14

1. Treat bacterial vaginosis
2. Progesterone
3. Cervical sutures
4. Reduce number of fetuses in multipregnancies

Question 15

Progesterone cream

Answer 15

In high risk women reduces the recurrence of pre term labour

Question 16

Cervical sutures

Answer 16

To help with cervical weakness.

Question 17

PPROM definition

Answer 17

breakage of the amniotic sac before the onset of labor

Question 18

Risk factor causing PPROM

Answer 18

1. Chorioamnionitis

Question 19

Chorioamnionitis

Answer 19

Inflammation of the amnion and chorion due to bacterial infection
- caused by bacteria ascending from gaina into uterus

Question 20

Symptom of PPROM

Answer 20

1. Gush

2. Constant trick;le or dampness

Question 21

Symptoms of chorioamnionitis

Answer 21

1. Fever + Malaise
2. Abdominal pain
3. Purulent/offensive discharge

Question 22

Examination of chorioamnionitis

Answer 22

1. Maternal pyrexia and tachycardia
2. Uterine tenderness
3. Fetal tachycardia

Question 23

Speculum in Chorioamnionitis shows;

Answer 23

Offensive vaginal discharge - yellow/brown

Question 24

Ix of PPROM

Answer 24

1. FBC and CRP - raised WCC and CRP indicate infection
2. Swabs of vagina
3. MSY

Question 25

What examination must you not do in suspected chorioamnionitis

Answer 25

VAGINAL EXAM AS THIS INCREASES THE RISK OF INTRODUCING INFECTION

Question 26

Management of PPROM depends on;

Answer 26

If caused by chorioamnioitis or not

Question 27

PPROM caused by infection

Answer 27

1. Steroids
2. Deliver whatever gestation
3. Broad spectrum antibiotic cover

Question 28

PPROM not caused by infection

Answer 28

1. Admit
2. Give steroids
3. Give antibiotics - erythromycin

Question 29

Risks to fetus from PPROM

Answer 29

1. Prematurity
2. Infection
3. Pulmonary Hypoplasia
4. Limb contractures