Extreme prematurity and perinatal management TOG 2018

Question 1

According to NICE< tests for PTB should not be offered before what gestation?

Answer 1

29+6
Instead if clinically PTL - give tocolytics and steroids

Question 2

According to NICE to offer/recommend nifedipine if intact waters and TPL?

Answer 2

Consider 24-25+6
Offer >26

Question 3

3 main scenarios for managing labour in 22-25+6 - threshold of viability.

Answer 3

1. Active - CS if fetal concerns - full rhesus. Risks of classical CS.
2. Passive - no CS but rhesus
3. Palliative - comfort care if live birth.

Need to discuss steroids, MgSu, tocolysis. Can rediscuss as pregnancy continues.

Question 4

In breech deliveries 24-27 weeks how common is fetal head entrapment?

Answer 4

9% VD
6% CS
Cord prolapse more common

Question 5

Risk of classical CS
24 weeks
28 weeks
30 weeks

Answer 5

24 weeks 20%
28 weeks 12-13%
30 weeks <5%

Question 6

Risks of classical CS

Answer 6

Higher risk scar rupture
Future subfertilty
Higher maternal mobidity (bleeding, paralytic ileus)

Question 7

Serious maternal complication
- Classical CS
- LS CS
- Vaginal delivery

Answer 7

• Classical CS 30%
• LS CS 12%
• Vaginal delivery 3.5

haemorrhage (blood loss <1500 ml, blood transfusion, or hysterectomy for haemorrhage),
Infection (endometritis, wound dehiscence, or wound infection requiring antibiotics), intensive care unit admission, or death

Question 8

After delivery what Ix should be sent to investigate cause of PTD?

Answer 8

Placenta histology
Microbiology
URine culture
Kleihauer
Hx - smoking, drug use, domestic violence