Preterm labour/PPROM

Question 1

What is P-PROM

Answer 1

Preterm prelabour rupture of membranes - before 37 weeks

Question 2

What is ROM

Answer 2

Rupture of membranes - amniotic sac ruptured

Question 3

SROM

Answer 3

Spontaneous rupture of membranes

Question 4

Whaat is PROM

Answer 4

Prelabour rupture of membranes - before onset of labour
OR
Prolonged rupture of membreanes - more than 18 hours before delivery

Question 5

When are babies considered non viable

Answer 5

Before 23 weeks

Question 5

When are babies considered non viable

Answer 5

Before 23 weeks

Question 6

When is resuscitation not considered in babies showing no signs of life

Answer 6

23-24 weeks

Question 7

Classification of prematurity

Answer 7

• Under 28 weeks: extreme preterm
• 28 – 32 weeks: very preterm
• 32 – 37 weeks: moderate to late preterm

Question 8

Prophylaxis of preterm labour

Answer 8

Vaginal progesterone
Cervical cerclage

Question 9

How does vaginal progesterone stop preterm labour

Answer 9

Decreases activity of myometrium and prevent cervix remodelling in prep for delivery

Question 10

Who is offered vaginal progesterone

Answer 10

Cervical length of less than 25mm on vaginal US between 16 and 24 weeks gestation

Question 11

What is cervical cerclage

Answer 11

stitch in cervix to add support and keep it closed - spinal or generla anaesthetic
Removed when enters labour or reaches term

Question 12

Who is offered cervical cerclage

Answer 12

<25mm on vaginal US cervical length, 16-24 weeks gestation and prev premature birth or cervical trauma eg colonoscopy and cone biopsy

Question 13

When is rescue cervical cerclage offered

Answer 13

16 and 27+6 weeks
Cervical dilatation without ROM to prevent progression and prem delivery

Question 14

Diagnosis of membrane rupture

Answer 14

Speculum examination - polling of amniotic fluid in the vagina

Question 15

What tests are performed when doubt about ROM diagnosis

Answer 15

Insulin like growth factor binding protein (IGFBP-I) - tested on vaginal fluid
Placental alpha-microglobulin-I (PAMG0I) - similar alternative
Fibronectin

Question 16

Managmenet of ROM

Answer 16

Prophylactic antibiotics - prevent development of chorioamnionitis

Question 17

What antibiotics give in ROM

Answer 17

Erythromycin 250mg 4 times daily for 10 days or until labour initiated

Question 18

What is preterm labour with intact membranes

Answer 18

Regular painful contraction and cervical dilatation without rupture of amniotic sac

Question 19

What needs to be done to diagnose preterm labour - 30 weeks before vs after

Answer 19

<30 weeks - clinical assessment is enough to offer management
>30 weeks - transvaginal US - assess cervial length

Question 20

What cervical length can offer management for preterm labour vs not on transvaginal US after 30 weeks

Answer 20

<15mm can offer
>15 mm - preterm labour unlikely

Question 21

What is foetal fibronectin?

Answer 21

Glue between chorion and uterus
Found in vagina druing labour

Question 22

What level of foetal fibronectin indicates preterm labour is unlikely

Answer 22

<50ng/ml - negative

Question 23

How to improve outcomes of preterm labour

Answer 23

Foetal monitoring (CTG or intermittent auscultation)
Tocolysis with nifedipine
Maternal corticosteroids
IV magnesium sulphate
Delayed cord clamping or cord milking

Question 24

What is tocolysis

Answer 24

Using medications to stop uterine contractions

Question 25

What is the medication of choice for tocolysis

Answer 25

Nifedipine - CCB

Question 26

What is used as an alternative for nifedipine in tocolysis

Answer 26

Atosiban - oxytocin receptor antagonist

Question 27

When can tocolysis be used

Answer 27

24 and 33+6 weeks gestation

Question 28

Why is tocolysis used

Answer 28

delay delivery and buy time for further fetal development, administration of maternal steroids or transfer to a more specialist unit (e.g. with a neonatal ICU). Only used as a short term measure

Question 29

How many weeks gestation give antenatal steroids before

Answer 29

36 - lungs still no deceloped eg two doses of IM betamethasone - 34 hours

Question 30

What helps protect the foetal brain during premature delivery

Answer 30

IV magnesium sulfate

Question 31

What drug decrease the chance of cerebral palsy

Answer 31

IV magnesium sulphate

Question 32

When is IV magnesium sulphate given

Answer 32

Within 24 hours of delivery of preterm babies less than 34 weeks gestation Given as bolus, followed by infusion upt o 24 hours after birth

Question 33

What do mothers need monitoring for when on IV magnesium sulfate

Answer 33

Magnesium toxicity at least four hourly

Question 34

How monitor for magnesium toxicity

Answer 34

Tendon reflexes - patella reflex Monitor obs Sigsn: Reduced resp rate Reduced BP Absent reflexes