Preterm Labour

Question 1

Define preterm labour

What is threatened preterm labour (TPTL)?

Answer 1

Labour before 37 wks

Contractions without cervical effacement or dilation

Question 2

How does it present?

Answer 2

Preterm uterine contractions, becoming regular and with intervals decreasing
P-PROM

Question 3

Risk factors - LIST SOME

Answer 3

Previous preterm labour

Multiple of pregnancies

Obstetrics complications - PET, APH

Maternal co-morbidities - DM, HTN

Anatomical - abnormal uterine anatomy, previous abortions

Infections - UTI, BV

Question 4

Prevention:

What can be given PV to reduce risk of preterm labour? - P

What is cervical cerclage and when is it used?

Answer 4

Vaginal progesterone

A cervical stitch
Rx for cervical weakness, when the cervix starts to shorten and open too early during a pregnancy

Question 5

Investigations:

For a woman with intact membranes:

• What is done to look for cervical dilation?
• What imaging can be done to look at cervical dilation?
• What is the fetal fibronectin test? Where is it done? What does a positive result mean?

Answer 5

Speculum and PV exam

TVUS

A protein not usually detected in vaginal secretions between 22 and 36 wks.
Bedside
+ve = high chance of entering premature labour within 7 days

Question 6

Investigations:

For a woman with suspected P-PROM:

• What would you see on speculum?
• Why is a PV exam not done?

Intrauterine infection:

• Bloods and why? - 2
• Fetal monitoring - 1
• Why is a urine dip done?
• Why is an HSV done?

Answer 6

Pooling of amniotic fluid

It can delay the subsequent onset of labour and inceases the risk of intrauterine infection risk

FBC - WBC raised
CRP - inflammaton
Fetal HR on CTG

Urine dipstick + MC+S - UTI

HSV = GBS

Question 7

Investigations:

Established preterm labour:
- Fetal monitoring used? - 2

Answer 7

CTG

Intermittent auscultation if low risk

Question 8

Management:

Steroids are given to all mothers <35 wks:

• Name
• Route
• How are the doses given?
• Why are steroids given? - 2

Tocolysis (<33 wks):

• What does it do?
• What does it allow enough time for?
• Name of drug used - N - also used as antiHTN in preg

Answer 8

Betamethasone

IM

2 doses 24 hrs apart

Helps fetal surfactant production, lowering mortality
Also reduces the risk of cerebral palsy
—
Suppresses premature labour

Admission of glucocorticoids

Nifedipine

Question 9

Management:

Why is IV magnesium sulfate given <34wks?

What is given until established labour for a P-PROM?

What is given as GBS prophylaxis during labour?

Answer 9

For neuroprotection (<34 wks)

Erythromycin PO

Benzylpenicillin

Question 10

Management:

What should a baby <28 wks be put into?

What temperature should the room be?

Where should they be transferred to?

Why should you wait 3 minutes to cut the cord and hold the baby 20 cm below the opening of the vagina?

What occurs neurologically in 20% of babies born between 24-26 wks?

Answer 10

A plastic bag with the head sticking out
The room should be 26*C.

NICU

Results in higher haematocrit levels
Reduces transfusion and oxygen supplement requirements

Cerebral palsy