Preterm delivery

Question 1

define preterm delivery. (1)

Answer 1

Delivery between 24 and 37 weeks gestation.

Question 2

Name 3 causes of preterm delivery. (3)

Answer 2

Subclinical infection, cervical “incompetence”, multiple pregnancy, antepartum haemorrhage, diabetes, polyhydramnios, fetal compromise, uterine abnormalities, idiopathic, iatrogenic.

Question 3

Describe three methods of preventing preterm labour. (3)

Answer 3

Cervix: cervical cerclage (insertion of suture into cervix) Can be performed, prepregnany, electively at 12-14 weeks, or as rescue.

• Progesterone suppositories
• Screening and treatment of STIs and UTI
• Selective TOP in multiples
• Polyhydramnios: needle aspiration (amnioreduction), NSAIDs

Question 4

Harriet is 33 weeks pregnancy but has started having contractions, US also shows a shortened cervix.
What is the next step in management? (2)
Name 2 drugs that can be used as tocolytics? (2)

Answer 4

Between 24 and 34 weeks, give steroids to hasten maturation of the fetal lungs.
They require 24 hours to act so labour can be delayed for up to 24 hours using tocolysis. It can also facilitate in utero transfer to a NICU.
Nifedipine, Atosiban.

Question 5

What is chorioamnionitis? (2)

Answer 5

Bacterial infection of the fetal membranes.
Characterised by contractions or abdominal pain, fever, tachycardia, uterine tenderness, coloured/offensive liquor.
Antibiotics will not cure, delivery is required.

Question 6

What is PPROM? (2)

Answer 6

Preterm prelabour rupture of membranes before 37 weeks.

Question 7

What is the management of premature, pre labour rupture of the membranes? (2)

Answer 7

Weigh up risks of prematurity with risk of infection.
Admit and give steroids if <34 weeks.
Monitor for signs of infection, monitor CTG.
Induce if reaches 36 weeks.