Preterm Labor and Postterm Pregnancy MCQs

Fibronectin is a glycoprotein that binds the fetal membranes to the decidua. Normally it is found in the cervicovaginal discharge before 22 weeks and again after 37 weeks of pregnancy. Presence of fibronectin in the cervicovaginal discharge between 24 weeks and 34 weeks is a predictor of preterm labor. When the test is negative it reassures that delivery will not occur within the next 7 days . Reference : D C Dutta’s textbook of obstetrics 8 th edition, chapter 22

Contraindications to tocolysis Intrauterine fetal demise Lethal fetal anomaly Nonreassuring fetal status Severe preeclampsia or eclampsia Maternal bleeding with hemodynamic instability Chorioamnionitis Preterm prelabor rupture of membranes Reference : laxmi sheshadri principles of obstetric, 1 st edition, chapter-35

In the early stages of labour pain is mainly uterine in origin because of painful uterine contraction "The pain of uterine contractions is distributed along the cutaneous nerve distribution of T 10 to L 1 In later stages pain is due to dilatation of the cervix. "The pain of cervical dilatation and stretching is referred to the back through sacral plexus." Reference : Dutta Obs 7/e, pg 117

Obstructive rupture-This is the end result of an obstructed labor. The rupture involves the anterior lower segment and usually extends through one lateral side of the uterus to the upper segment. The margins are ragged and necrosed. Nonobstructive rupture-Grand multipara are usually affected and rupture usually occurs in early labor. Weakening of the walls due to repeated previous births as mentioned earlier may be the responsible factor. The rupture usually involves the fundal area and is complete. Reference: D C Dutta’s textbook of obstetrics 8 th edition, chapter 29

Management of obstructed labor: Prompt Management of dehydration and ketoacidosis—by giving IV fluids Antibiotics are given to prevent infection Most important step is to relieve obstruction by either instrumental delivery or by doingLSCS. LSCS may even have to be done, if the baby is dead to relieve the obstruction otherwise uterine rupture can occur. The two main principles in the management of obstructed labor are: Never wait and watch Never use oxytocin Reference : Dutta Obs 7/e, p 59

3 layers of uterus Endometrium Myometrium Perimetrium/serosal Layers of myometrium Outer longitudinal Middle interlacing Inner circular The middle layer is the thickest of the three and consists of bundles of muscle separated by connective tissue. There is a tendency for the muscle bundles to interlace, and as the blood vessels which supply the uterus are distributed in the connective tissues, the caliber of the vessels is in part controlled by the contraction of the muscle cells. The purpose of this layer is therefore in part hemostatic. This layer is described as living ligatures of the uterus , and is responsible for control of bleeding in the third stage of labor. Reference: Shaw’s textbook of gynecology, 16th edition, chapter 1

GRAND MULTIPARA ARE AT RISK OF UTERINE RUPTURE. RISK FACTORS OF UTERINE RUPTURE INCLUDE: PREVIOUS CS (CLASSICAL > LSCS ) OBSTRUCTED LABOR( NON SCARRED ) GRAND MULTIPARA MISOPROSTOL : It is contraindicated for IOL in previous CS Pts. OXYTOCIN. KEYWORDS: M/C sign: non reassuring FHR Most specific: loss of station Generalised pain Hypotension Loss of uterine contour Fetal parts superficially palpable Reference: D C Dutta's textbook of obstetrics 8th edition, chapter 29

American College of Obstetricians and Gynecologists (2020e) defines preterm labor to be regular contractions accompanied by a change in cervical dilation, effacement, or both or to be regular contractions and cervical dilation of at least 2 cm at initial presentation. fFN: Detected in cervicovaginal secretions in women who have normal pregnancies with intact membranes at term, fFN appears to reflect stromal remodeling of the cervix before labor . Reference : Williams obstetrics 26 th edition, chapter 45