PRETERM LABOUR IN PREMATURE DELIVERY

Question 1

Definition of preterm labour

Answer 1

Labour after 28 weeks but before 37 completed weeks of gestation

Question 2

Risk factors of preterm labour

Answer 2

Low socioeconomic status
Smoking
Young age

Question 3

Causes of preterm labour

Answer 3

Maternal infections
Premature rupture of membranes
Incompetent cervix
Multiple pregnancies
Placenta abruption
Diabetes mellitus
Preeclampsia/ eclampsia

Question 3

Maternal infections associated with preterm labour

Answer 3

UTIs: pyelonephritis
Malaria
Intrauterine infections

Question 4

Symptoms of preterm labour

Answer 4

There may be show
Regular and painful uterine contractions or abdominal pains

Question 5

Signs of preterm labour

Answer 5

Effacement and dilatation of the cervix
Rapture of membranes
Palpable repetitive uterine contractions
Small maturity

Question 5

Investigations in preterm labour

Answer 5

FBC
FBS/RBS
Ultrasound scan

Question 6

Purpose of ultrasound scan in preterm labour

Answer 6

Gestational age
Presentation
Lie
Placental site
Amniotic fluid volume
Foetal weight

Question 6

Treatment objectives in preterm labour

Answer 6

Stop uterine contractions if labour is not fully established
Allow foetal growth and maturity if possible
Allow foetal lung maturation (28-34 weeks)
Allow labour to progress if already established
Treat any underlying causes

Question 7

Non-pharmacological management

Answer 7

Avoid sex
Avoid strenuous exercise
Bed rest
Cervical cerclage for cases due to cervical incompetence

Question 8

Drugs for tocolysis

Answer 8

Salbutamol
Nifedipine
Magnesium sulphate

Question 9

Dosing for salbutamol in tocolysis

Answer 9

Dissolve 2.5mg salbutamol in 500ml of D5W to get 0.5%w/v.
Initial infusion at 10mcg/min, Increase gradually every 10 mins till contractions diminish
Then increase slowly to till contractions cease, maximum of 45mcg/minutes
maintain rate after contractions cease for an hour and reduce by rate by 50% every 6 hours, maximum duration of 48 hours

Question 10

Dosing for nifedipine in tocolysis

Answer 10

Nifedipine oral 20mg initially
Repeat dose after 90mins
If contractions persit, give 20mg every 3-4 hours to a max of 160mg/day for a maximum of 48-72 hours

Question 11

Dosing for magnesium sulphate in tocolysis

Answer 11

6g of IV Magnesium sulphate given over 20mins
Then 2g infusion per hour based on response

Question 12

Dose foe betamethasone in foetal lung maturation

Answer 12

0.6-7mg every 24 hours (2 doses)
Now 12mg bd for 24 hours`

Question 12

Drugs for foeatal lung maturation

Answer 12

Dexamethasone
Betamethasone

Question 12

Dose for dexamethasone in foetal lung maturation

Answer 12

6mg bd for 48 hours

Question 13

When is antenatal corticosteroids most effective

Answer 13

if delivery occurs at least 24 hours after the first dose of the medicine has been given and less than 7 days after the last dose of the medicine.

Question 14

When do we acoid antenatal corticosteroids

Answer 14

When infection is present

Question 15

Dangers of steroid use in preterm labour

Answer 15

Susceptibility to infection
Fluid retention
Pulmonary edema
Maternal postpartum collapse