Preterm Labour, Premature Rupture of Membranes (PROM), and Tocolysis Flashcards
(27 cards)
What is the definition of preterm labour?
Regular uterine contractions with cervical change leading to expulsion of fetus/placenta between 28–36 weeks + 6 days.
What gestational age defines preterm birth?
Between 28 weeks and 36 weeks + 6 days gestation.
How many contractions per hour are typically needed to cause cervical change?
More than 4 contractions per hour.
What is the significance of preterm labour?
Leading cause of neonatal morbidity, mortality, and low birth weight; very costly; 2/3 of infant deaths.
Name 4 major risk factors for preterm labour.
Previous preterm labour, infections, cervical causes, uterine abnormalities, low BMI, short interpregnancy interval, stress.
What proportion of preterm labour cases are idiopathic?
50% (half).
What drug is used for preterm labour prevention and how is it administered?
17-α hydroxyprogesterone acetate; administered PV or IM.
At what gestational age is progestin started and stopped for prevention?
From 16–20 weeks up to 36–37 weeks.
List 4 symptoms or signs of preterm labour.
Uterine contractions, cervical dilation/effacement, ‘show’, vaginal bleeding, increased discharge.
What investigations are done for suspected preterm labour?
FBC, MSU (urine), USS, swabs (ECS, HVS, LVS), fetal fibronectin, amniocentesis.
What is the difference between preterm contractions and cervical insufficiency?
Preterm contractions: contractions without cervical change. Cervical insufficiency: cervical change without contractions.
What are the complications of preterm labour?
Premature birth with complications like RDS and neurological injury.
What determines whether to adopt an expectant or intervention approach in treatment?
Gestational age, estimated fetal weight, and contraindications to labour suppression.
What are examples of expectant management?
Cases <28 weeks or >34 weeks gestation.
List the intervention strategies used in preterm labour.
Bed rest, corticosteroids, tocolysis, antibiotics, magnesium sulfate (24–32 weeks), delivery, cord pH and gases.
What is tocolysis?
Use of medication to suppress preterm labour to reduce fetal morbidity/mortality.
What are the indications for tocolysis?
High-risk patients, positive fetal fibronectin, short cervix, cervical changes.
Name 5 classes of tocolytics with examples.
β-mimetics (e.g. ritodrine), Magnesium sulphate, Calcium channel blockers (e.g. nifedipine), Prostaglandin inhibitors (e.g. indomethacin), Oxytocin antagonists (e.g. atosiban)
What is PROM?
Rupture of membranes before onset of active labour.
When is PROM considered prolonged?
If >24 hours.
What percentage of PROM cases occur after 37 weeks?
0.95
How is PROM diagnosed on speculum examination?
Pooling of fluid in posterior fornix; alkaline on Nitrazine paper; ferning on dry slide.
What are clinical signs of chorioamnionitis?
Fever, maternal leukocytosis, uterine tenderness, maternal/fetal tachycardia, foul-smelling liquor.
What are the differential diagnoses for PROM?
Physiologic discharge, vaginal infection, cervical mucus plug.
