Preterm labour, Premature rupture of membranes and Tococlysis

Question 1

What is the definition of preterm labour?

Answer 1

Preterm labour is the occurrence of regular uterine contractions with cervical change between 28 weeks and 36 weeks and 6 days of gestation.

Question 2

How many uterine contractions per hour are typically required to cause cervical change?

Answer 2

More than four uterine contractions per hour are needed to cause cervical change.

Question 3

What is the significance of preterm birth?

Answer 3

Preterm birth is a leading cause of neonatal morbidity and mortality, low birth weight, and accounts for 2/3 of infant deaths.

Question 4

What proportion of preterm births are idiopathic?

Answer 4

Approximately half of all preterm births are idiopathic.

Question 5

Name some risk factors for preterm labour.

Answer 5

Risk factors include previous preterm labour, infections, cervical or uterine abnormalities, low prepregnancy weight, smoking, and stress.

Question 6

How can preterm labour be prevented?

Answer 6

Preterm labour can be prevented with progestin administration between 16–20 weeks and 36–37 weeks, reducing risk by 30%.

Question 7

List common symptoms and signs of preterm labour.

Answer 7

Symptoms and signs include uterine contractions, cervical dilation, vaginal bleeding, increased discharge, and passage of ‘show.’

Question 8

How is the gestational age of a fetus estimated?

Answer 8

Gestational age is estimated from the last menstrual period (LMP) or early ultrasound scans.

Question 9

What investigations are conducted for preterm labour?

Answer 9

Investigations include fetal fibronectin tests, amniocentesis, swabs for infections, and ultrasound scans.

Question 10

What are the differential diagnoses for preterm labour?

Answer 10

Differential diagnoses include preterm contractions (no cervical change) and cervical insufficiency (cervical change without contractions).

Question 11

Name complications associated with preterm birth.

Answer 11

Complications include respiratory distress syndrome (RDS) and neurological injuries.

Question 12

How is treatment for preterm labour categorized?

Answer 12

Treatment is categorized as expectant or intervention, depending on gestational age and contraindications.

Question 13

What are the components of expectant management for preterm labour?

Answer 13

Expectant management includes bed rest, corticosteroids, antibiotics, and magnesium sulfate for fetal neuroprotection.

Question 14

What is tocolysis?

Answer 14

Tocolysis involves using medication to suppress uterine contractions and delay labour.

Question 15

What are the indications for tocolysis?

Answer 15

Indications for tocolysis include high-risk pregnancies, positive fibronectin tests, short cervix, and cervical changes.

Question 16

Name five types of tocolytic drugs.

Answer 16

Types of tocolytic drugs: beta-mimetics, magnesium sulfate, calcium channel blockers, prostaglandin synthase inhibitors, oxytocin antagonists.

Question 17

What are the limitations of beta-mimetic adrenergic agents like ritodrine?

Answer 17

Beta-mimetics are limited by dose-related cardiovascular side effects in both mother and fetus.

Question 18

How does magnesium sulfate act as a tocolytic?

Answer 18

Magnesium sulfate inhibits calcium uptake into smooth muscle cells, reducing uterine contractility.

Question 19

What is the mechanism of action for calcium channel blockers like nifedipine?

Answer 19

Calcium channel blockers like nifedipine block calcium uptake via voltage-dependent channels in uterine muscle cells.

Question 20

What is the definition of premature rupture of membranes (PROM)?

Answer 20

PROM is the rupture of membranes before the onset of active labour and is prolonged if more than 24 hours.

Question 21

How is PROM diagnosed clinically?

Answer 21

PROM is diagnosed by pooling of amniotic fluid, alkaline reaction on Nitrazine paper, and fern patterns on slides.

Question 22

What are the clinical features of chorioamnionitis?

Answer 22

Clinical features of chorioamnionitis include fever, uterine tenderness, tachycardia, foul-smelling amniotic fluid, and maternal leukocytosis.

Question 23

What are some differential diagnoses for PROM?

Answer 23

Differential diagnoses include physiological vaginal discharge and vaginal infections like bacterial vaginosis.

Question 24

What are the key components of PROM treatment?

Answer 24

PROM treatment includes antibiotics, corticosteroids, and magnesium sulfate for neuroprotection.

Question 25

What percentage of PROM cases occur after 37 weeks of gestation?

Answer 25

Ninety-five percent of PROM cases occur after 37 weeks of gestation.

Question 26

What are some complications associated with PROM?

Answer 26

Complications of PROM include infection, preterm labour, and neonatal complications.

Question 27

How is fetal neuroprotection achieved in cases of preterm labour?

Answer 27

Fetal neuroprotection is achieved using magnesium sulfate between 24 and 32 weeks of gestation.

Question 28

What is the purpose of corticosteroids in managing preterm labour?

Answer 28

Corticosteroids promote fetal lung maturity and reduce neonatal complications.

Question 29

Why is magnesium sulfate administered between 24–32 weeks?

Answer 29

Magnesium sulfate protects against neurological injuries, such as cerebral palsy, in preterm infants.

Question 30

What are some social factors contributing to preterm labour?

Answer 30

Social factors contributing to preterm labour include low socioeconomic status, short interpregnancy intervals, smoking, and stress.