Preterm Labour

Question 1

Def

Answer 1

Birth at < 37 completed weeks of gestation

Question 2

Cause

Answer 2

1. Premature activation of fetal hypothalamic pituitary adrenal axis
   (Maternal & fetal stress)
2. Exaggerated inflammatory response
3. Decidual haemorrhage
4. Pathological uterine overdistension
5. Cervical dis

Question 3

Max risk factors

Answer 3

1. Previous preterm birth
2. Bleeding
3. Multi fetal pregnancy
4. H/o cervical incompetence

Question 4

Consequences in newborn
1. Immediate
2. Late

Answer 4

1. RDS
   ICH
   NEC
   Hypothermia hypoglycemia
   Infection
   Retinopathy of prematurity
2. Neurological disturbance like CP
   Increased IMR

Question 5

Prediction by

Answer 5

Cervical length by TVS b/w 16-24 w
<2.5 cm predictive
<2 cm diagnostic

Question 6

Indication of cervical length screening

Answer 6

1. H/o preterm birth
2. Other risk factors like polyhydromnios , short CX diagnosed on routine usg

Question 7

Prevention of PTL

Answer 7

1. Cervical cerclage
2. Progesterone
   ( 17 alpha hydroxyprogesteron caproate 250 mg im weekly frm 16-24 till 36 weeks or vaginal micronized proges. 100-200 mg tab daily)
3. Low dose aspirin
4. Cessation of smoking

Question 8

Cx circlage:
1. Indication
2. C/I

Answer 8

1. </=24 weeks
   Previous h/o PTB
   Cx length<2.5 cm
   Singleton pregnancy
2. No previous h/I PTB with short CX
   • mgt progesterone
     Multiple pregnancy with or without short cx

Question 9

Diagnostic criteria
ACOG

Answer 9

I. Regular uterine contractions with progressive dilatation n effacement of Cx
Regular uterine contractions+ dilatation of Cx atleast 2cm on initial presentation

Question 10

Conventional criteria

Answer 10

Uterine contractions>/=4 in 20 min
>/=8 in 60 min +
Anyone of the following
1. Cervical dilatation>/=3 cm
2. Cx length</=2 cm on TVS
3. Cx length b/w 2-3 cm + fetal fibronectin protein+nt