Preterm Labour

Question 1

What is preterm labour

Answer 1

Uterine contractions productive of cervical changes(dilatation and effacement) b/w 24-37 weeks

Question 2

Preterm birth

Answer 2

Preterm induced labour
Preterm elective c section
Spontaneous preterm labour

Question 3

Fetal implications of preterm birth

Answer 3

1- RDS
2- intracranial haemorrhage
3- metabolic problems like hypothermia, hypoglycaemia, impaired hematpoesis causing anemia and prolonged physiological jaundice
4- infections
5- tocolytic related side effects
6- inc mortality
7- inc morbidity such as cerebral palsy, blindness, sensorineural deafness and inguinal hernia

Question 4

Maternal implications of preterm birth

Answer 4

1- anxiety
2- tocolytic side effects such as tachycardia and pulmonary oedema
3- expense
4- operative delivery

Question 5

Rx of RDS

Answer 5

If it doesn’t resolve in 72 hours, intubation and ventilatory support and exogenous surfactant therapy

Question 6

Risk factors for preterm labour

Answer 6

Age less than 18 years, or greater than 35 years, maternal smoking, low BMI, two previous first trimester pregnancy loss,2 previous therapeutic abortions, 1 2nd trimester pregnancy loss, multiple pregnancy, polyhydramnious, pelvic inflammatory disease, acute pyelonephritis, appendicitis, cervical incompetence, fibroid, Asherman syndrome, pregnancy with an IUD inserted, fetal fibronectin, maternal CRH

Question 7

Diagnosis of labour

Answer 7

6-8 contractions in 1 hour and cervical changes at 2 consecutive examinations performed 4 hours apart.
Or
On a single examination the cervix is dilated about 2 cm and effaced about 80 percent

Question 8

Braxton hicks contractions

Answer 8

All pregnant woman get them after 24 weeks but they are infrequent, painless, and have no effect on the cervix.
Pelvic examination performed after 4 hours will exclude labour.

Question 9

Investigations for labour

Answer 9

1- CTG
2- lecithin/sphingomyelin ratio
3- cervical swab. To identify the microorganism that is responsible for the preterm labour.

Question 10

Management of preterm labour

Answer 10

Either immediate delivery or conservative management upto 37 weeks

Question 11

Immediate delivery in preterm labour

Answer 11

1- continuation of pregnancy is hazardous such as intrauterine fetal death, intrauterine growth restriction, fetal distress, chorioamnionitis, cord prolapse, cervix greater than 4 cm dilated.
2- tocolytic are contraindicated such as HTN, DM, placental abruption, cardiopulmonary disease, anemia, multiple gestation, maternal hyperthyroidism

Question 12

Tocolytic

Answer 12

1- beta sympathomimetics (salbutamol, ritodrine, terbutaline)
2 - magnesium sulfate
3 - prostaglandin synthethase inhibitors (indomethacin)

Question 13

When should beta sympathomimetics be discontinued

Answer 13

Contractions become less than 1 in 15 minutes or maternal heart rate increases to 140 beats/min

Question 14

Side effects of beta sympathomimetics

Answer 14

Palpitations. Arrythmia. MI. Pulmonary oedema(most fatal)

Paralytic ileus
Hyperglycaemia
Hypokalemia
Elevated transaminase levels

Question 15

Prevention of intraventricular haemorrhage

Answer 15

Vitamin K and phenobarbital

Question 16

When are corticosteroids contraindicated

Answer 16

Chorioamnionitis

Question 17

When is c section done for a preterm baby

Answer 17

Baby in breech less than 1.5 kg.

Twin pregnancy where twin A is in a non-vertex position

Question 18

Prevention of preterm labour

Answer 18

Bed rest and no coitus, nipple stimulation.
Also
1- cervical cerclage at 14-16 weeks.
2- prophylactic antiobiotics for cervical infection.
3- prophylactic tocolytics

Question 19

Prelabour rupture of membranes

Answer 19

Can be either pre term or term

Question 20

Preterm spontaneous rupture of membranes most common cause

Answer 20

Genital infections amongst the other causes of preterm labour

Question 21

Most fitting examination for preterm spontaneous membrane rupture

Answer 21

Sterile speculum examination

Question 22

Tests for preterm spontaneous membrane rupture

Answer 22

1- nitrazine blue test
2- ferning test
3- dye test

Question 23

Fetal complication of srom

Answer 23

Cord prolapse

Question 24

Maternal complication of srom

Answer 24

Placental abruption

Question 25

Most common complication of srom

Answer 25

Fetal infection

Question 26

Prolonged srom complication

Answer 26

Reduced liquor volume leading to pulmonary hypoplasia, limb deformities and cord compression

Question 27

Management of srom preterm

Answer 27

Delivery or conservative management

Question 28

Type of delivery in cord prolapse

Answer 28

Caesarian section

Question 29

Monitoring in conservative management of preterm labour

Answer 29

Maternal temperature 4 hourly
TLC once a day
Inspection of pad for meconium/pus twice a day
Uterine palpating for tenderness twice a day