Preterm, postterm labour, PROM, CTG

Question 1

Preterm labour, mx

Answer 1

20wks- before 37wks

1. Tocolytics - nifedipine/MgSo4/atosiban
2. Steroids - lung maturity
   26-32wks

No point of tocolytics if 1st stage of labour started

*No need of antibiotics

Question 2

Premature rupture of membrane

Answer 2

PROM
1. Membrane rupture before onset of labour (Normally onset of labour .. rupture)

2. 50% deliver in 24hrs
3. No Vaginal exam … chorioamnionitis

Question 3

Mx of PROM

Answer 3

1. Speculum exam - swab
2. Erythromycin prophylaxis
3. WBC count/CRP, CTG every 2-3days to check for infection
4. Induce delivery <36wks if
   Infection signs+
   Unstable mom/baby
5. > 36wks - induce labour

Question 4

Postterm preg

Answer 4

1. > 42wks
2. CTG, AFI @41wks … if normal … induce labour at 42wks
   (Amniotic fluid index)

Question 5

When is a CTG abn and requires action

Answer 5

Any 2 of following
1. FHR 100-109 or 160-170bpm
2. Variability reduced. (3-4bpm in 40 mins)
normal - 6 to 25bpm 3. Decelerations - variable without complicating features normal - 15bpm for 15sec

Any 1 of following
1. FHR <100 or >170
2. Variability of FHR absent (<3)
3. Decelerations prolonged (>90sec) or variable with complicating features