Pre-Term

Question 1

What is Preterm delivery?

Answer 1

• Occurs between 24-37weeks
• 5-8% deliveries are preterm
• Spontaneous /iatrogenic –pre eclampsia

Question 2

complications of preterm labour

Answer 2

Neonatal-
• NeonatalSCBUadmission
• 20% perinatal mortality
• 50%cerebralpalsy
• Respiratory distress
• Cognitive ad behavioural
problems

Long term for baby-
• Chronic lung disease
• Blindness
• Minordisability

Maternal risks-infection • LSCScommon

Question 3

preterm labour Aetiology

Answer 3

• Lower socioeconomic class
• Extremes age
• Renal failure
• Diabetes
• Thyroid disease
• Pre-eclampsia
• IUGR
• Malegender
• STs
• Bacterialvaginosis
Aetiology
• Previous cervical surgery • Multiple pregnancy
• Uterine abnormalities
• UTI
• Polyhydramnios
• Congenital fetal malformations • APH

Question 4

MEchanims of preterm labour

Answer 4

• Infection- in 60% of cases
• Bacterial vaginosis is a risk factor
• Trichomonas/chlamydia
• UTI
• Twins- excessive stretching/polyhydramnios
• Iatrogenic in pre-eclampsia
• Placental abruption
• Uterine abnormalities
• Cervical incompetence-painless dilatation of cervix followed by delivery

Question 5

Prediction of preterm labour

Answer 5

• History-previous history of preterm labour and late miscarriage
Investigations-
• TVS-Cervical length

Question 6

Prevention of preterm labour

Answer 6

Cervical cerclage- is insertion of one or more sutures in the cervix to strengthen and keep it closed
• 12-14weeks
Progesterone supplementation-
• Vaginal suppositories from early pregnancy • Treat infections

Question 7

Clinical features of pre term labour

Answer 7

History-painful contractions
• Bleeding
• Fluid loss
• Painless dilatation in cervical incompetence
Examination-
• Fever
• Always check lie and presentation • Dilated cervix on examination

Question 8

Investigations of preterm labour

Answer 8

• Fetal fibronectin- negative result means preterm delivery in next week is unlikely
• TVS- if cervical length is more than 15mm – delivery unlikely
• Vaginal swabs
• CRP
• WBC

Question 9

Management of pre term labour

Answer 9

• Steroids- 23-34 weeks
• Give in women who has fibronectin positive and have short
cervix
• Steroids- reduces perinatal morbidity and mortality
• By promoting fetal lung maturity
• Dexamethasone 9.9mg IM 2 doses 24 hrs apart
• Magnesium sulphate- neuroprotective effect if given 12 hours before the anticipated preterm delivery
• 23-34 weeks

Question 10

what is Tocolysis?

Answer 10

• Delay preterm labour
• Relaxes uterus
• Are given-
• To allow time for steroids to act
• For in utero transfer of the women if no SCBU bed is available • Nifedipine or oxytocin receptor antagonists (atosiban)

Question 11

What is Chorioamnionitis? how is it treated?

Answer 11

• Infection of inflammation and infection of chorion and amnion • IV antibiotics
• Immediate delivery whatever the gestation

Question 12

What should be considered during delivery in pre term labour?

Answer 12

• Vaginal delivery
• LSCS for obstetric indications
• Paediatrician should attend the delivery • Forceps is used rather than ventouse
• Have better survival if treated in level 3 neonatal intensive care unit
• Mother should be transferred to level 3 unit for delivery