Quiz 5: Preterm labour and preterm rupture of the membranes

Please choose the one, most correct answer to each question or statement.

1. What is the definition of preterm labour?
   • Labour starting 1 hour or more after rupture of the membranes
   • Labour starting before 40 weeks of gestation
   • Labour starting before 37 weeks of gestation
   • Labour starting when the fetus is assessed as weighing less than 2000 g, when the gestational age is unknown
2. Preterm rupture of the membranes is defined as:
   • Membranes that have ruptured at term, and not been followed by the onset of labour within 24 hours
   • Membranes that rupture before the second stage of labour
   • Membranes that have ruptured before 37 weeks of gestation, in the absence of contractions
   • Membranes that have ruptured before the onset of labour at any gestational age
3. Preterm labour is important because it commonly results in death of the infant due to:
   • Abruptio placentae
   • Birth trauma
   • Jaundice
   • Hyaline membrane disease
4. Chorioamnionitis is usually caused by:
   • Bacteria which cross the placenta from the maternal circulation to the fetus
   • Bacteria which spread from the cervix and vagina
   • Viral infection of the genitalia
   • Candida vaginitis
5. Choose the correct statement regarding chorioamnionitis:
   • It causes all cases of preterm labour
   • It always follows preterm rupture of the membranes
   • It may cause and complicate preterm rupture of the membranes
   • It only occurs in patients with vaginitis
6. Chorioamnionitis usually results in:
   • No signs or symptoms in the mother or fetus
   • Maternal pyrexia and tachycardia
   • An offensive vaginal discharge
   • Abdominal tenderness
7. Clinical chorioamnionitis may present with:
   • Headache and backache
   • Vaginal bleeding
   • Fetal tachycardia
   • Dysuria and frequency
8. Antibiotics should be given to:
   • All patients with preterm rupture of the membranes
   • All infants with preterm labour
   • Patients with clinical signs of chorioamnionitis
   • Patients with ruptured membranes, where the pregnancy is allowed to continue
9. Which of the following commonly causes preterm labour?
   • Multiple pregnancy
   • Excessive weight gain during pregnancy
   • A breech presentation
   • No sexual intercourse in the second half of pregnancy
10. Which patients are at the highest risk of preterm labour?
    • Patients who book early in pregnancy
    • Multigravidas
    • Patients with a history of preterm labour in a previous pregnancy
    • Patients living in low socio-economic circumstances
11. Women at increased risk of preterm labour should:
    • Increase their normal amount of exercise
    • Not take baths
    • Not be examined vaginally at the antenatal clinics
    • Avoid coitus during the second half of their pregnancies
12. Braxton Hicks contractions:
    • Are sometimes uncomfortable but are not painful
    • Are regular
    • Are associated with cervical dilatation
    • Increase in duration and frequency
13. Patients with preterm rupture of the membranes should have:
    • A digital vaginal examination to assess the state of the cervix
    • A sterile speculum examination only
    • No vaginal examination at all
    • Only a rectal examination
14. The pH of amniotic fluid is:
    • Acid
    • Neutral
    • Alkaline
    • Variable
15. If a patient presents with preterm labour, the first step in the management is to:
    • Do a vaginal examination to evaluate cervical dilatation and effacement.
    • Do an abdominal examination to evaluate the frequency and duration of uterine contractions.
    • Do a sterile speculum examination to see whether liquor is draining from the cervix.
    • Estimate the gestational age as accurately as possible and rule out fetal distress.
16. Nifedipine (Adalat) should not be used in a patient with:
    • Asthma
    • Preterm rupture of the membranes
    • Multiple pregnancy
    • Hypertension
17. The initial dose of salbutamol (Ventolin) to suppress preterm labour, is:
    • 50 µg
    • 100 µg
    • 250 µg
    • 500 µg
18. Indomethacin (Indocid) may be more dangerous to the fetus if given at or beyond:
    • 28 weeks
    • 32 weeks
    • 34 weeks
    • 36 weeks
19. A patient with preterm rupture of the membranes, who is allowed to continue with her pregnancy, must:
    • Have an examination at least twice daily for signs of clinical chorioamnionitis
    • Be admitted to hospital for complete bed rest
    • Be seen at the antenatal clinic at least weekly, as she has a high-risk pregnancy
    • Have daily white cell counts
20. It is recommended that pregnancy be allowed to continue in the presence of preterm rupture of the membranes (unless there are contraindications) until the duration of pregnancy reaches:
    • 40 weeks
    • 37 weeks
    • 34 weeks
    • 32 weeks