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Questions and Answers
Which of the following is a risk factor for premature rupture of the membranes?
Which of the following is a risk factor for premature rupture of the membranes?
What is a confirmed method for diagnosing premature rupture of membranes?
What is a confirmed method for diagnosing premature rupture of membranes?
Which complication can arise from premature rupture of membranes?
Which complication can arise from premature rupture of membranes?
What management is recommended for patients with premature rupture of membranes at 24 to 34 weeks gestation?
What management is recommended for patients with premature rupture of membranes at 24 to 34 weeks gestation?
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Which is NOT considered a cause of premature rupture of membranes?
Which is NOT considered a cause of premature rupture of membranes?
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What is the primary difference between early and late preterm labor?
What is the primary difference between early and late preterm labor?
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Which of the following is NOT a risk factor for preterm labor?
Which of the following is NOT a risk factor for preterm labor?
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What is the main clinical presentation of preterm labor?
What is the main clinical presentation of preterm labor?
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Which drug is recommended for enhancing lung maturity in a fetus if the gestational age is 34 weeks or more?
Which drug is recommended for enhancing lung maturity in a fetus if the gestational age is 34 weeks or more?
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What is a contraindication for the use of Indomethacin in preterm labor management?
What is a contraindication for the use of Indomethacin in preterm labor management?
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Which medication is administered rectally for tocolysis in preterm labor?
Which medication is administered rectally for tocolysis in preterm labor?
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Which of the following is a cardinal sign of labor?
Which of the following is a cardinal sign of labor?
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What side effect is associated with Magnesium sulfate treatment in preterm labor?
What side effect is associated with Magnesium sulfate treatment in preterm labor?
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Study Notes
Preterm Labor
- Preterm labor is labor that begins after the fetus is viable (capable of surviving outside the womb) and before 37 weeks of gestation.
- It's classified into early preterm labor (before 33 weeks) and late preterm labor (between 34 and 36 weeks).
- Risk factors include:
- History of preterm labor
- History of miscarriage during the middle trimester
- History of premature rupture of the amniotic membrane
- Short cervix (less than 2.5 cm at 20-25 weeks, measured by transvaginal ultrasound)
- Diabetes during pregnancy
- Hypertension (high blood pressure)
- Infections (bacterial vaginosis, urinary tract infection, bacterial colonization with Group B Streptococcus)
- History of cervical surgery
- Smoking
- Illicit drug use (e.g., cocaine, heroin)
- Placental abruption
- Excessive amniotic fluid (polyhydramnios)
Clinical Presentation and Signs of Preterm Labor
- Clinical presentation often includes lower abdominal pain and backache.
- Leakage of amniotic fluid (water breaking) may occur.
- Uterine contractions can be palpated and assessed using a tocograph.
- Cervical dilation, diagnosed by a pelvic exam, is the key sign of labor.
Investigations for Preterm Labor
- High vaginal swab and endocervical swab for culture and sensitivity testing.
- Total white blood cell count.
- Urinalysis.
- Transvaginal ultrasound to measure cervical length.
Management of Preterm Labor (Gestational age < 34 weeks)
- Steroid administration (dexamethasone 12mg every 12 hours for 4 doses, or betamethasone 12mg every 24 hours for 2 doses) to enhance fetal lung maturity, if gestational age is 34 weeks or more.
- Tocolytic therapy (drugs to stop labor): Indomethacin (100 mg per rectum for 4 doses, followed by 50 mg orally twice a day for 2 days; not prescribed after 32 weeks.) Contraindications for use include maternal and fetal kidney disease and severe oligohydramnios.
- Other tocolytic drugs like magnesium sulfate, terbutaline.
Preterm Rupture of the Membranes (PROM)
- Rupture of amniotic membranes prior to the onset of labor.
- Occurs before 37 weeks of gestation.
- Risk factors include low body mass index, prior miscarriage, prior preterm labor, prior PROM, diabetes, and hypertension.
Symptoms and Signs of PROM
- Leakage of amniotic fluid.
- Diagnosis confirmed by visualization of the amniotic fluid coming from the cervix via speculum examination.
Complications of PROM
- Intra-amniotic infection (leading to sepsis, maternal, and fetal death)
- Abruptio placentae (premature separation of the placenta).
- Cord prolapse (umbilical cord coming out of the vagina before the baby).
- Fetal pulmonary abnormalities.
Management of PROM
- 24–34 weeks gestation: Corticosteroids for fetal lung maturity (dexamethasone or betamethasone) and antibiotics (erythromycin or ampicillin).
- Monitoring maternal and fetal temperature, blood pressure, and vaginal discharge.
Additional Notes
- Increased risk of cesarean section with preterm labor and PROM.
- Neonatal complications, including respiratory distress syndrome (RDS).
- Fluid sample collection from the posterior vaginal fornix for microbiological analysis.
- Avoid using vacuum extraction to prevent complications in PROM.
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Description
This quiz covers the essential aspects of preterm labor, including its definition, classifications, and risk factors associated with it. Learn about the clinical presentation and signs that may indicate preterm labor and how they impact pregnancy. Enhance your understanding of maternal health and fetal viability.
