PROM

Question 1

Define pre-term labour

Answer 1

Onset of labour (regular, painful contractions a/w progressive cervical changes with/without ROM)

< 37 completed wks of gestation

Question 2

List some complications of PTL more significant in gestations < 34wks?

Answer 2

HMD, ICH, infections, NEC

Question 3

Outline the management principles of PTL

Answer 3

Assess gestation

Establish the diagnosis

Ascertain a cause

Decide on tocolysis/steroids

Question 4

Define tocolytic

Answer 4

Drug used to suppress labour

In order to administer steroids to enhance fetal lung maturity

Question 5

For how long are tocolytics continued?

Answer 5

48 hrs

Question 6

What is the dosage of nifedipine (tocolytic drug of first choice and CCB, ‘Adalat’) used in PTL?

Answer 6

Initially: 30mg orally then 20mg after 90min

If contractions persist: 20mg 6hrly

Question 7

What are two NB C/I’s to CCB (Nefidipine, ‘Adalat’)?

Answer 7

Hypovolaemia

Cardiac conditions

Question 8

What is the MOA of B₂ adrenergic agents (e.g. salbutamol, ‘Ventolin’) as a tocolytic agent, and what are some of its S/E’s?

Answer 8

Uterine smooth muscle relaxant

Maternal and fetal tachycardia, hyperglycaemia

Question 9

What are some common S/E’s of CCB (e.g. nefidipine, ‘Adalat’) tocolysis?

Answer 9

Headache

Flushing

Nausea

Question 10

What is the dosage of salbutamol (Ventolin) used for tocolysis?

Answer 10

250mcg diluted in 9.5mL water as slow IV bolus

Question 11

What are 4 NB C/I to B2 adrenergic tocolysis?

Answer 11

Stenotic valvular lesions

Shock

DM

Thyrotoxicosis

Question 12

What is the MOA of prostaglandin antagonists (e.g. indomethacin) in tocolysis?

Answer 12

Blocks the conversion of AA to prostaglandin E₂ and F₂α

Question 13

What is the dosage of indomethacin used in tocolysis?

Answer 13

100mg rectally 12hrly for 48hrs

Question 14

What are S/E’s of prostaglandin antagonists (e.g. indomethacin) in tocolysis?

Answer 14

GIT irritation

RF

Supression of platelet function

Premature closure of ductus arteriosus

Question 15

What are 3 NB C/I to prostaglandin antagonist (e.g. indomethacin) tocolysis?

Answer 15

Throbocytopaenia

Peptic ulcer disease

Fetal gestation > 32 wks

Question 16

Name the tocolytic not used in state hospitals (expensive) and outline its MOA

Answer 16

Atosiban

Oxytocin receptor antagonist (blocks oxytocin reeptors in the uterus)

Question 17

When may a rescue course of steroids be given?

Answer 17

If the initial dose is given at very early gestation (e.g. 27 wks)

Question 18

What did the ORACLE III trial show wrt antibiotic use in PTL?

Answer 18

No benefit except in those in whom ROM had also occurred

Question 19

Define prelabour preterm ROM (PPROM)

Answer 19

Leakge of amniotic fluid through the cervix

< 37wks of gestation

Must be differentiated from heavy vaginal discharge or involuntary passage of urine

Question 20

List 7 causes of ROM < 37 wks (i.e. PPROM)

Answer 20

1. intra-uterine infection
2. Incompetent cervix
3. Iatrogenic ROM (IOL)
4. Interference (a/w infection)
5. Complication of amniocentesis
6. Complication of ECV
7. Uterine overdistension (e.g. polyhydramnios, multiple pregnancy)

Question 21

Outline the management principles of PPROM

Answer 21

> 35wks: deliver

< 34wks: conservative

Question 22

Outline the conservative management of PPROM

Answer 22

Bed rest

Sterile pads changed 2hrly

Avoid PV’s

Adminster steroids

Assess fetal growth, amniotic fluid

Monitor for signs of maternal infection (CTG, clinical exam, twice weekly WCC + CRP)

Oral antibiotics e.g. erythromycin

Deliver if signs of intrauterine infection or fetal distress