W11_02 Preterm labour and PPROM

Question 1

define “term pregnancy”

Answer 1

between 37 and 40 weeks

Question 2

define preterm pregnancy

Answer 2

before 37 weeks

Question 3

note preterm births account for 75% of perinatal mortality

Answer 3

ok

Question 4

what are the three main causes of preterm labour?

Answer 4

spontaneous;
PPROM;
indicated preterm birth

Question 5

what are three parts of the labour process?

Answer 5

progesterone withdrawal;
oxytocin initiation;
decidual activation (inflammation?)

Question 6

how long before labour does cervical effacement start

Answer 6

4-8 weeks pre-labour

Question 7

most risk factors are ASSOCIATED with preterm labour, but are NOT CAUSATIVE

Answer 7

ok

Question 8

what’s the biggest risk factor for preterm labour?

Answer 8

previous preterm birth

Question 9

what lifestyle factors contribute to preterm labour?

Answer 9

smoking, low BMI, high BMI, substance use, stress

Question 10

what demographic factors contribute to preterm labour?

Answer 10

age, race/ethnicity, SES, education (all maternal factors)

Question 11

note: women who have bacterial vaginitis have less preterm labour if the infection is treated

Answer 11

ok

Question 12

note: multiple pregnancies can increase risk of preterm labour

Answer 12

ok

Question 13

note: bleeding is associated with increased risk of preterm labour

Answer 13

ok

Question 14

which cervical and uterine issues increase risk for preterm labour?

Answer 14

previous spontaneous preterm birth;
uterine anomaly;
cervical insufficiency;
pervious cervical procedure (LEEP, cone)

Question 15

note: short inter-pregnancy interval is associated with increased risk of preterm labour

Answer 15

ok

Question 16

note: anemia and thrombophilia are two risk factors for preterm labour

Answer 16

ok

Question 17

how to diagnose preterm labour?

Answer 17

regular contractions that lead to cervical dilation

Question 18

what’s fetal fibronectin?

Answer 18

shouldn’t be present in vaginal secretions before 35 weeks; has a high negative predictive value of preterm labour

Question 19

what’s tocolysis?

Answer 19

medical therapy to try and slow down labour

Question 20

what are contraindications to tocolysis? (“need to know”)

Answer 20

maternal medical conditions;
chorioamnionitis;
bleeding previa/abruption;
intrauterine growth restriction;
contraindications to specific agents;
mature fetus;
intrauterine fetal demise;
imminent delivery

Question 21

what’re nifedipine, indomethacin?

Answer 21

tocolysis agents

Question 22

what’s magnesium sulphate?

Answer 22

slows contractions, but not indicated for tocolysis

Question 23

note: mag sulphate, antocin/atosiban/tractocil, ritodrine/terbutaline are NOT indicated for tocolysis

Answer 23

ok

Question 24

what infection to screen for in a woman with preterm labour?

Answer 24

GBS. If positive, treat. If not, don’t treat. Prevent GBS sepsis in neonate

Question 25

how do steroids help in preterm labour?

Answer 25

reduction in rates of neonatal death, RDS, IVH, with associated reduction of NEC, resp support, NICU admission, infections in first 48 hours of life

Question 26

when are steroids beneficial in preterm labour?

Answer 26

26-34+6 weeks. But recommended up to 24 weeks

Question 27

which steroids to give for preterm labour?

Answer 27

betamethasone and dexamethasone; just one course is good

Question 28

what does magnesium sulphate do?

Answer 28

maternal neuroprotection (esp eclampsia);
fetal neuroprotection (cerebral palsy)

Question 29

note: might be good to delay cord clamping in a preterm delivery

Answer 29

ok

Question 30

define PPROM

Answer 30

preterm premature rupture of membranes

Question 31

how can PPROM lead to neonate death?

Answer 31

prematurity;
sepsis;
pulmonary hypoplasia

Question 32

how to diagnose PPROM?

Answer 32

speculum exam, and the fluid is seen to pool in the posterior fornix. “Ferning” of fluid sample under the microscope

Question 33

note: check for chorioamnionitis!

Answer 33

can become sepsis in mother AND fetus

Question 34

what are signs of chorioamnionitis?

Answer 34

maternal vital signs, fetal heart rate, abdominal tenderness/pain, elevation in WBC

Question 35

what are risks of pre-viable PPROM?

Answer 35

lung hypoplasia, limb contractures

Question 36

can you give tocolysis in PPROM up to 34 weeks?

Answer 36

no

Question 37

how to treat PPROM <34 weeks?

Answer 37

antibiotics (erythromycin, ampicillin) shown to help a little

Question 38

how to manage PPROM >34 weeks?

Answer 38

toss up - it’s prematurity vs. sepsis