Preterm Labour & Birth

Question 1

What is the risk of stillbirth in a) white, b) black, c) Asian, d) wealthy, e) deprived babies?

Answer 1

a) 32:10,000
b) 72:10,000
c) 51:10,000
d) 23:10,000
e) 47:10,000

Question 2

Who should be offered a choice of PV progesterone vs cervical cerclage?

Answer 2

1. Hx of spontaneous PTB or 2nd trimester loss AND
2. Cx length ≤ 25mm

Question 3

What is the dosing of prophylactic vaginal progesterone?

Answer 3

200mg
From 16-24/40 to at least 34/40

Question 4

Who should be offered prophylactic vaginal progesterone?

Answer 4

1. Hx of spontaneous PTB or 2nd trimester loss OR
2. Cx length ≤ 25mm

Question 5

Who should be offered prophylactic cerclage?

Answer 5

1. Cx ≤ 25mm AND
2. Hx PPROM OR
3. Hx cervical trauma

Question 6

How is PPROM diagnosed?

Answer 6

1. Sterile speculum examination,
2. If pooling of fluid, no diagnostic test
3. If no pooling of fluid, test: IGF-1 or PAMG-1

Question 7

What do IGF-1 & PAMG-1 stand for?

Answer 7

Insulin-like growth factor 1
Placental alpha-microglubulin-1

Question 8

What antibiotics should be given in PPROM?

Answer 8

1. Erythromycin 250mg QDS
2. Oral penicillin if CI, but not co-amoxiclav

Question 9

How should infection be identified in PPROM?

Answer 9

Combination of clinical Ax & tests:
1. CRP
2. WCC
3. CTG

Question 10

When is emergency cervical cerclage not offered?

Answer 10

1. Signs of infection
2. Active PV bleeding
3. Uterine contractions

Question 11

When is emergency cervical cerclage considered?

Answer 11

1. 16-27+6/40
2. Dilated Cx & exposed unruptured fetal membranes
3. In discussion with obs & paeds consultants