Preterm labour

Question 1

What are the causes of pre-term labour?

Answer 1

Most cases are idiopathic
Weak cervix (Following cervical surgery)
Antepartum haemorrhage (Placenta praevia, placental abruption)
Chorioamnionitis
Uterine abnormality
Gestational diabetes
Pre-eclampsia

Question 2

What investigations would you do for suspected preterm labour?

Answer 2

Speculum examination for pooling of fluid

Foetal fibronectin

Question 3

What is the management of premature rupture of membranes?

Answer 3

Expectant management for 24 hours

Induction of labour after 24 hours

Question 4

What is the management of preterm labour?

Answer 4

Tocolysis (Buy time for steroids)

• Nifedipine
• Atosiban

Steroids (Lung maturation)

• Betamethasone
• Dexamethasone

Magnesium sulphate

• Reduces risk of cerebral palsy
• Also inhibits uterine contraction

Delivery after 48 hours ideally

Question 5

What is the management of preterm premature rupture of membranes?

Answer 5

Admit for monitoring

Antibiotics
- Erythromycin (PO) for 10 days

Steroids (Lung maturation)

• Betamethasone
• Dexamethasone

DO NOT ATTEMPT TOCOLYSIS

Conservative management

Question 6

How do you diagnose chorioamnionitis?

Answer 6

Clinical features:
Fever (Very sensitive), uterine fundal tenderness, maternal tachycardia (>100/min), fetal tachycardia (>160/min) and purulent or foul amniotic fluid

Investigation:
Amniotic fluid culture

Question 7

Which bacteria cause chorioamnionitis?

Answer 7

E. coli
Streptococcus
E. faecalis

Question 8

What major consequence might chorioamnionitis have for the foetus?

Answer 8

Foetal brain damage (periventricular leukomalacia)

Question 9

What is the management of chorioamnionitis?

Answer 9

Ceftriaxone and metronidazole

Induce labour

Question 10

How can preterm labour be prevented?

Answer 10

Prophylactic vaginal progesterone
- Offered to women with TVUSS at 16-24 weeks showing cervical length <25mm and no previous history of PPROM

Cervical cerclage

• Normally put in 11-14 weeks for those with TVUSS at 16-24 weeks showed cervical length < 25 mm AND history of midtrimester (16-34 weeks) pregnancy loss
• Baby born by c-section

Rescue cerclage can be performed if 16-27 weeks with a dilated cervix and unruptured membranes