Preterm Labour

Question 1

definition of preterm labour

Answer 1

<37 weeks

Question 2

Cervical changes in labour

Answer 2

Collagen breakdown
Change in proteoglycan conc.
Increased water
Increase in leukocyte and MP inflitration

Question 3

Causes of preterm labour

Answer 3

Maternal:
maternal infection
haemorrhage
infection
cervical weakness
Stress

Foetal:
abruption
foetal stress

Question 4

RF for cervical weakness

Answer 4

Hx of 2nd trimester pregnancy loss

Previous cervical surgery

Question 5

What complication is associated with chorioamnionitis?

Answer 5

Foetal brain damage (due to INF) - periventricular leukomalacia

Question 6

RF for placental abruption

Answer 6

High BP
Alcohol 
Smoking 
Coke
trauma
Pre-elclampsia 
previous abruption
Thrombophilia
PPROM

Question 7

What test can you do to see if someone’s in PTL

Answer 7

Cervicovaginal foetal fibronectin

presence from 22-36wks puts you at risk of preterm labour

Question 8

Mx preterm labour

Answer 8

Admit to antenatal ward
maternal corticosteroids
tocolytics (to delay delivery enough for steroids)
1st line - nifedipine,
2nd line - atosiban (OTR antagonist)
IV MgSO4 (neuroprotection of neonate) if delivery is expected in 24 hours
NB - can give you resp depression and arrhythmia

Aim for delivery at 37 weeks

Question 9

What are some tocolytics?

Answer 9

CCB
OTR antagonist
b-2 agonist - ok but put you at risk of pulmonary oedema
NSAIDs - can lead to premature closure of ductus arteriosus which can put you at risk of pulmonary HTN. Also increase risk of necrotising enterocolitis and neonatal renal dysfunction
MgSO4 - reduce contractility

Question 10

What antibiotics fo you give for PPROM

Answer 10

10 days erithromycin

Question 11

Mx PPROM

Answer 11

Admit to antenatal ward
Prophylactic abx 10 days
maternal corticosteroids
Conservative before 34 weeks (unless signs of chorioamnionitis)
This means regular maternal bloods for infection and CTG. Also do vaginal swab but they don’t correspond well to risk of chorioamnionitis

Induce at 37 weeks

Question 12

2 methods of preventing preterm delivery

Answer 12

Progesterone

Cervical cerclage

Question 13

3 indications for cervical cerclage

Answer 13

History of pre term labour
If cervix is shorter than 25mm and the woman has had previous surgical procedures (US guided cerclage)
If cervix is dilating without contractions

Question 14

Prevention of preterm labour

Answer 14

Vaginal progesterone (give between 16-24 weeks)  -
indications: hx of spontaneous preterm birth (<34 wks) or late miscarriage >16 wks AND/OR cervical length <25mm

Prophylactic cervical cerclage -
indications:
hx of spontaneous preterm birth (<34 wks) or late miscarriage >16 wks AND cervical length <25mm
- cervical length <25mm AND hx of cervical trauma

Rescue cerclage:
cervical dilation in absence of uterine contractions (or other signs of labour between 16-27+6)

Question 15

Dx PPROM

Answer 15

Offer speculum 
If positive treat for PPROM
If negative do alpha 1 microglobulin or inslulin like growth factor binding protein 1.
If these are positive treat for PPROM 
If negative sack it off

Question 16

contraindications for cervical cerclage

Answer 16

infection
active contractions
vaginal bleeding

Question 17

When to tx preterm labour

Answer 17

Treatment is necessary if woman is less than or equal 29+6

Question 18

What is the management if you suspect preterm labour and the mother is >30 weeks?

Answer 18

Do TVUSS to see if birth is possible in 48 hours (look at cervical length)
If cervix<15mm she’s in preterm labour
If cervix is equal or greater than 15mm she’s ok
If US findings are unacceptable consider foetal fibronectin (if -ve it rules PTL out)

Question 19

When to give tocolytic

Answer 19

Consider between 24-25+6 if intact membrane and PTL
Give between 26-33+6 if intact membrane and PTL
If nifedipine contraindicate give OTR antagonist

Question 20

When to give steroids

Answer 20

If birth is expected before 36 weeks

Question 21

When to giv magnesium

Answer 21

Give if 24-29+6wks and they’re in PTL or expecting to deliver in 24 hours
Consider if 30-33+6 and giving birth in 24 hours

Question 22

What is P-PROM

Answer 22

preterm premature rupture of membrane in absence of uterine activity (before 37 weeks)

Question 23

what is PROM

Answer 23

rupture of membrane in absence of uterine activity after 37 weeks

Question 24

Mx of PROM

Answer 24

Admit
Consider Abx
Monitor intensely for chorioamnionitis
Expectant mx for 24 hrs if liquor is clear
After this IOL

Question 25

What are the stats regarding when mothers with PPROM deliver?

Answer 25

50% of mums with PPROM deliver within 1 week

Question 26

What are the risk factors for PPROM?

Answer 26

previous PPROM
smokers
STI
multiple pregnancy