Preterm Labor

Question 1

What is preterm birth

Answer 1

After 20wks and before 37 completed

Question 2

Upon which does the mortality and morbidity depend on in preterm labor

Answer 2

Gestational age

Question 3

What are the risk factors for preterm labor

Answer 3

1- prev
2- poor placenta implantation 
3- iatrogenic (pre-eclampsia\IUGR\thrombo)
4- ART (AVF) 
5- maternal (advanced age, disease, obesity)
6- multiple gestations 
7-  rupture of membrane 
8- APH & cervical incompetency 
9- stress

Question 4

What is early pre-term

Answer 4

<32 weeks

Question 5

What is the most common factor for preterm

Answer 5

Unkown

Question 6

What is the most known common factor for preterm

Answer 6

infection

Question 7

Name infection that is associated w\preterm

Answer 7

BV

Question 8

How does infection affecting the cervicx cause preterm labor

Answer 8

Disrupt the fetal membrane > release FFN and preterm labor

Question 9

What is a placental cause of preterm labor

Answer 9

• abnornal trophoblast invasion

- progestrone dysregulation

Question 10

How does stress induce preterm labor

Answer 10

Cortisol and catecholamine

Question 11

How does uterine stretch cause preterm labor and where do we commonly see it

Answer 11

Cause failure of parathyroid related protein PTrP

We see it in: multiple gestation, polyhydraminos & macrosomia

Question 12

What is the role of PTrP?

Answer 12

Keeping the myometrium muscles relaxed

Question 13

What are the most common causes of preterm labor (spont, or, induced)

Answer 13

Spontanous

Question 14

Name iatrogenic causes of preterm birth

Answer 14

Placenta previa or abruptio, fetal growth restriction, multiple gestation, pre-eclampsia

Question 15

How to predict the chance of preterm labor

Answer 15

Fibronectin test

Question 16

What does the fibronectin test indicate

Answer 16

Labor could happen within 7 days

Question 17

What is the diagnostic criteria for preterm labor

Answer 17

• uterine contraction (4 per 20\8 per 60)

- cervical changes (80% effaced or 2cm dilated)

Question 18

What is the investigation that you’d like to do for patients undergoing preterm labor

Answer 18

CTG, US, HVS, baseline investigation + cervical assessment

Question 19

What is the initial management that you’d like to do for these patients with preterm labor

Answer 19

1- Bed rest, hydration
2- antibiotics
3- steroid (+- tocolytics)

Question 20

Is bed rest actually affective in preterm labor

Answer 20

Yes 20% the contraction will stop

Question 21

What are the AB that are usually given in preterm labor

Answer 21

Ab for 48 hours

Question 22

What is the role of steroids in preterm

Answer 22

Induce lung maturity

Question 23

Why do we give tocolytics in preterm labor

Answer 23

1- give time for transfer
2- give time for steroid to work

(Postpone labor for 48 hours)

Question 24

What are the uterine tocolytic agents used in preterm labor

Answer 24

PCOS NO bleeding

• PGs
• Cyclooxygenase (indomethacin)
• Sulfate
• Nifedipine
• oxytocin antagonist

Question 25

What is the maximum side effect for the - mother - fetal

Answer 25

- B-blocker (tribtualine) | - indomethacin

Question 26

What is the most commonly used tocolytic

Answer 26

Nefidipine

Question 27

What tocolytic medication should be avoided\indicatedfor cardiac patients

Answer 27

avoided: Nefidepine Indicated: atopan

Question 28

What is the role of magnesium sulfate

Answer 28

Lung maturation, prevent eclampsia, neuroprotection

Question 29

What is the maternal complication in preterm

Answer 29

- Retained plcacenta | - need of c\s

Question 30

What is the risk on fetus for preterm

Answer 30

RDS, patent ductus, retinopathy, hypoglycemia and thermia, anemia

Question 31

What medication stimulate the closuer of ductus arteriosus

Answer 31

Indomethacin

Question 32

What is the definition of premature rupture of membrane?

Answer 32

Spontanous rupture of membrane (amniorrhexis)before onest of labor - preterm premature: before 37 weeks

Question 33

What are the causes for premature rupture of membrane

Answer 33

- unknown - vaginal\cervical infection - abn membrane physiology (apoptosis 2ndary to oxidative stress) - cervical insufficiency - nutritional def.

Question 34

How to diagnose PROM

Answer 34

1- hx of vaginal loss of fluid 2- amniotic fluid in vagina 3- speculum + US

Question 35

What are the tests for sterile examination to diagnose PROM

Answer 35

Pooling - ferning - nitrazine - amnisure

Question 36

What is pooling test?

Answer 36

Leakage by vision

Question 37

What is fening test

Answer 37

Swab from posterior vernix

Question 38

What is nitrazine test?

Answer 38

PH test, if alkaline this is either sperm or leaking of amniotic fluid

Question 39

What is amnisure

Answer 39

Alpha-microglobulin-1

Question 40

What are the US findings if there’s PROM?

Answer 40

AFI<5cm

Question 41

What are the ddx for PROM

Answer 41

Urinary incontience, leucorrhea (discharge) - loss of mucus plus - vaginal infection or secretion

Question 42

What is the property of the amniotic sac and fluid

Answer 42

Sac: mechanical protection against infection Fluid: bacteriocidal effect

Question 43

Is intact membranes an absolute barrier to infection?

Answer 43

No, there’s hematogenous spread of infections

Question 44

What is the workup for PROM

Answer 44

Same as preterm labor except add th amniotic sample for culture & sensitivity

Question 45

How to treat PROM

Answer 45

Same as PTL

Question 46

When to deliver patient with PROM and when to provide medications

Answer 46

According to GA - >or equal to 36 - <36

Question 47

What if there’s PROM with no contraction >or equal to 36

Answer 47

- Induction of labor within 6-12hrs | - if no evidence of infection & cervix isn’t favorable > in 24hrs

Question 48

What is the management of PPROM <36

Answer 48

- if stable, no contraction & infection: expectant until lung maturation. - antibiotics - look for chorioaminitis

Question 49

How to diagnose chorioaminitis?

Answer 49

- Temp>= 38 w\no infection - fetal tachycardia - uterine tenderness & irritability on CTG - leukocytosis

Question 50

What is the Ab used in PPROM?

Answer 50

IV erythromycin 48hrs then PO 5x

Question 51

When is it applicable to manage these patients as outpatient

Answer 51

- no infection - normal AFI - well educated - vertex presentation - closed cervix - home instructions

Question 52

What are the home instructions to give to patients with PPROM

Answer 52

1- no coital activity or PA 2- monitor temp because PROM=infection 3- weekly hospital visit\CTG\ growth

Question 53

What if there’s chorioaminitis in PROM?

Answer 53

Immidiate delivery is indicated

Question 54

Is it recommended to give tocolysis to patients with chorioaminitis?

Answer 54

Not recommended