Pre-term Labour

Question 1

define term

Answer 1

37 to 42 weeks

Question 2

define EDD

Answer 2

40 wks

Question 3

define pre term

Answer 3

<37 wks

Question 4

what % births are preterm

Answer 4

8

Question 5

what % of preterm births are elective

Answer 5

25

Question 6

reasons for intentionally delivering someone preterm

Answer 6

PET
IUGR

Question 7

define labour

Answer 7

regular contractions of uterus resulting in changes of cervix

Question 8

define extreme pre term

Answer 8

<28 wks

Question 9

define very preterm

Answer 9

28-32 wks

Question 10

define late to moderate preterm

Answer 10

32 to 37 wks

Question 11

when does all morbidity fall in terms of wks of gestation

Answer 11

32 weeks onwards

Question 12

preterm labour Ix

Answer 12

Hx
speculum / bimanual
USS
TVUSS - cervical lengthening
CTG (contractions)

Question 13

preterm labour RFs

Answer 13

prev preterm
twins
genital tract infections
PPROM
uterus issues - eg bicornate
cervix issues - eg LLETZ
placental issues
smoking, stress

Question 14

Sx of preterm labour

Answer 14

dull backache
abdo tightenings
lower abdo pressure
PVB or spotting
PROM - gush or trickle

Question 15

when should preterm labour be Tx (wks)

Answer 15

<29+6 wks
or >30 wks

Question 16

why is TVUS done in preterm labour

Answer 16

determine cervical length - very hard

Question 17

what is foetal fibronectin used for

Answer 17

to rule out preterm labour if its negative

Question 18

what does a positive foetal fibronectin indicate

Answer 18

nothing, can be false positive

Question 19

what causes a false positive of foetal fibronectin

Answer 19

sex
ROM
PVB

Question 20

what does a negative foetal fibronectin indicate

Answer 20

unlikely to start labour in 14 days

Question 21

what % of term vs preterm births have PPROM

Answer 21

3% term 30-40% preterm

Question 22

complications associated with PPROM

Answer 22

neonatal sepsis
cord prolapse
lung hypoplasia

Question 23

what is the average time from PPROM to birth

Answer 23

7 days

Question 24

Ix for PPROM

Answer 24

speculum - look for fluid
USS estimation of amniotic fluid if neg

Question 25

what result is diagnostic for PPROM

Answer 25

squirt of fluid out of cervix upon coughing in speculum exam

Question 26

Mx of PPROM inc specific drug, dose, freq & when to stop

Answer 26

oral ABx prophylaxis
- erythromycin 250mg 4x daily until labour or 10 day course

Question 27

what ABx should not be given for PPROM prophylaxis and why

Answer 27

co-amoxiclav - increased NEC risk

Question 28

what condition is there a risk of with PPROM & how is this monitored for

Answer 28

chorioamnionitis
CRP or temp

Question 29

when should steroids be given in PPROM

Answer 29

24 to 34 weeks

Question 30

when should tocolytics be considered for PPROM

Answer 30

benefit of maternal steroids

Question 31

when should tocolytics NOT be used in PPROM

Answer 31

foetal distress
APH
PET

Question 32

types of tocolytics indicated in PPROM

Answer 32

nifedipine (CCB)
atosiban (oxytocin antagonist)

Question 33

which steroids are given in PPROM

Answer 33

betamethasone or dexamethasone

Question 34

why are betamethasone / dexamethasone used in PPROM vs other steroids

Answer 34

cross placenta
no mineralocorticoid effect

Question 35

dose / route / freq of steroids in PPROM ?

Answer 35

12mg IM x2, 12 or 24 hours apart
then again after 2-7days

Question 36

purpose of MgSO4 in preterm labour

Answer 36

neuroprotective for preterm babies

Question 37

dose of MgSO4 for preterm labour

Answer 37

4g IV bolus over 15 mins

Question 38

for what is vaginal progesterone / cervical cerclage offered

Answer 38

preterm labour
2nd trimester miscarriage
cervical length <25mm in wks 16-24

Question 39

how does progesterone affect pregnancy

Answer 39

maintains the pregnancy through uterine quiescence

Question 40

when is cervical cerclage done

Answer 40

12 to 14 wks
rescue clerage done 23 wks

Question 41

what is cervical cerclage

Answer 41

stitching up cervix to narrow cervical os

Question 42

when is cervical cerclage removed

Answer 42

37 weeks