8 - Obs - Preterm Delivery - Prediction, Prevention + Clinical features

Question 1

Prediction
Hx: Those at incr ?, prev Hx of late ?/? labour, may have ?
and measures to prevent.

Invx: Even in ? risk, ? length (ext ? to int ?) on TVS is sens and spec. Prediction cant prevent.

Answer 1

risk
miscarriage
preterm
Ix

low
cervical
os
os

Question 2

Prevention
- limited to women at ? ? -> strategies begin at ? weeks

? Supplementation:
-Suppositories from ? preg reduce risk. Even in low risk women w ? cervix.

Infection:
Infection common but some ?
beneficial. Eg metronidazole ? risk of preterm. ? and trt of ???s, ???s and BV beneficial, role of Abx for other bacteria disputed.

Answer 2

high risk
12

progesterone
early
short

bacteria
increases
screening
STIs
UTIs

Question 3

Prevention

The Cervix:
Cervical cerclage = insertion of ?(s) into cervix to ? and keep ?. Common but ?
disputed. ? route usually but can be placed abdominally if cervix ? or ?. Usually pre preg and can be ?. Used in 3 cases: ? at 12-14wks esp if Hx of ? delivery. Cervix ? regularly and sutured if ?. Rescue suture that can prevent ? even when incompetent cervix is ?.

Fetal Reduction:
Reduction of higher order ?
offered at ?-?wks.

Answer 3

suture
strengthen
closed
efficacy
vaginal
short
scarred
laparoscopic
elective
preterm
scanned
shortening
delivery
dilated

multiple
10-14

Question 4

Prevention

Treatment of Polyhydramnios:
V high ? fluid volumes usually due to ? abnormality can be trt w needle aspiration (?) or, providing fetal ? is intensive, ?????s. Reduce fetal ? ? and occasionally cause reversible premature ? of fetal ??.

Treatment of Medical Disease:
Prevention of ? disease ass w ? disease reduces risk of preterm deliv. Women w thyroid abnorms may also benefit from ?.

Answer 4

amniotic
fetal
amnioreduction
surveillance
NSAIDs
UO
closure
DA

placental
autoimmune
thyroxine

Question 5

Hx point..
Painful ?. In over ? of these, contractions will stop ? and labour will not ensue til ?. With cervical ?, painless cervical ? may occur and woman experiences dull ?
ache or incr ?. ??? and fluid loss are common. Latter suggests ? ?.

Answer 5

contractions
half
spont
term
incompetence
dilatation
suprapubic
discharge
APH
ruptured membranes

Question 6

Ex points…
? may occur. ? and ? checked w abdo palp. VE unless ? ?. An effaced or ? cervix confirms diagnosis, but course of preterm labour is unpredictable and may be v ?
or v ?.

Answer 6

fever
lie
presentation
ruptured membranes
dilating
rapid
slow