Preterm labour

Question 1

Preterm birth definition

Answer 1

delivery between 24 - 37 weeks

Question 2

Risk factors for pre term deliivery

Answer 2

1. Previous pre term birth
2. Multiple pregnancy
3. Cervical surgery or uterine abnormalities
4. Pre eclampsiaor IUGR

Question 3

Acute pre term labour

Answer 3

Pre term labour associated with cervical weakness

- early opening of the cervic

Question 4

Presentation of pre term labour

Answer 4

1. Increased vagina discharge
2. Mild lower abdominal pain
3. Bulging membranes on examination

Question 5

Spontaneous rupture of membrane

Answer 5

Spontaneous rupture of the amniotic sack

- common presentation of pre term labour

Question 6

Ix of pre term labour

Answer 6

1. FBC and CRP
2. Ultrasound for fetal presentation
3. Fetal fibronectin assay should be positive

Question 7

Fetal fibronectin

Answer 7

Protein of the amniotic sac

1. Positive - high likelihood of pre term labour

Question 8

Transvaginal cervical length

Answer 8

> 15 mm unlikely to labour

Question 9

Management of preterm labour - DRUGS

Answer 9

1. Steroids Betametasone IM (two doses - 24 hours apart)
2. Tocolysis - nifedipine
   prolongs labour and delivery thus improving gestation

Question 10

Ix of management of preterm labour

Answer 10

1. Transvaginal cervical length scan

2. Fibronectin assay

Question 11

Benefit of giving steroids

Answer 11

1. Reduces rate of respiratory distress, intraventricular hemorrhage and neonatal death

Question 12

Sig of treating bacterial vaginosis

Answer 12

1. Reduce the risk of preterm prelabour rupture of membranes
2. Low birthweight in women with previous preterm birth

Question 13

How is bacterial vaginosis treated

Answer 13

Clindamycin rather than metronidazole

Question 14

Methods of preventing preterm labour

Answer 14

1. Treat bacterial vaginosis
2. Progesterone
3. Cervical sutures
4. Reduce number of fetuses in multipregnancies

Question 15

Progesterone cream

Answer 15

In high risk women reduces the recurrence of pre term labour

Question 16

Cervical sutures

Answer 16

To help with cervical weakness.