Preterm labour NICE

Question 1

Offer vaginal progesterone or prophylactic cervical cerclage to

Answer 1

Preterm birth/2nd trimester loss

and

Cx length <25mm 16-24 weeks

Question 2

Consider prophlyatic vaginal progesterone

Answer 2

Preterm birth/2nd trimester loss

or

Cx length <25mm 16-24 weeks

Question 3

When to start and stop vaginal progesterone

Answer 3

Start 16-24 weeks, continue until 34 weeks

Question 4

Consider cerclage if cervical length <25mm and …

Answer 4

Hx PPROM or cervical trauma

Question 5

When to consider emergency cervical cerclage

Answer 5

16-27+6 dilated cervix and exposed unruptured fetal membranes

Question 6

If > 30 weeks and suspected PTL

Answer 6

Offer TVUS for cervical length, if <15 mm - treat as preterm labour

Question 7

If >30 weeks and suspected PTL and USS not available

Answer 7

FFN if < 50 PTL unlikely
>50 Tx as PTL (tocolysis and steroids)

Question 8

If > 30 weeks and suspected PTL and no USS or FFN

Answer 8

Tx as PTL

Question 9

When to consider/offer tocolysis

Answer 9

Consider 24-25+6
Offer 26-33+6
Intact menebranes

If PTL and need steroids/transfer to higher level neonatal unit

Question 10

1st and 2nd line tocolytic

Answer 10

1st Nifedipine
2nd oxytocin receptor antagonist

Question 11

When to discuss, offer and consider steroids

Answer 11

Discuss 22-23+6
Offer 24-33+6
Consider 34-35+6

Consider < 34 weeks, steroids >7days ago

Question 12

When ti discuss, offer and consider MgSu

Answer 12

Discuss 23-23+6
Offer 24-29+6
Consider 30-33+6

Question 13

When can discuss/offer fetal scalp electrode or fetal blood sampling?

Answer 13

Do not perform < 34 weeks
Discuss 34-36+6
Offer > 37

Question 14

From what gestation to consider CS if breech in labour

Answer 14

26-36+6