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 one 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. Subclinical 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. Preterm labour is present when:
    • A patient experiences painful contractions prior to 37 weeks.
    • Regular uterine contractions, palpable on abdominal examination prior to 37 weeks is present.
    • Regular uterine contractions, palpable on abdominal examination and cervical effacement and/or dilatation on vaginal examination prior to 37 weeks.
    • A patient has a history of rupture of the membranes prior to 37 weeks irrespective of whether or not she has uterine contractions.
14. 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.
15. The pH of amniotic fluid is:
    • Acid.
    • Neutral.
    • Alkaline.
    • Variable.
16. How should a patient with preterm labour at a gestational age of 36 weeks be managed?
    • The patient should be delivered in a MOU or district hospital.
    • The patient should be delivered in a level 1 facility.
    • The patient should be referred to a level 2 facility for delivery.
    • Preterm labour should be suppressed and the patient transferred to a level 1 facility for further suppression of preterm labour.
17. What should be done if preterm labour has been diagnosed at a primary care antenatal clinic and the patient is less than 34 weeks pregnant?
    • Contractions need to be suppressed and the patient referred urgently to a level 2 hospital.
    • Contractions need to be suppressed and the patient referred urgently to a level 1 hospital.
    • There is no time to suppress contractions as this will only delay the urgent transfer of the patient.
    • If the cervix is less than 2 cm dilated it is better to wait to see if further dilatation occurs before transfer is arranged.
18. How would you decide that a patient is less than 34 weeks pregnant if the duration of the pregnancy is unknown?
    • The estimated fetal weight will be less than 2500 g and the syphysis-fundus measurement will be less than 34 cm.
    • The estimated fetal weight will be less than 2000 g and the syphysis-fundus measurement will be less than 33 cm.
    • If in doubt the patient should be referred to a level 2 hospital to be evaluated.
    • An ultrasound examination needs to be done urgently to establish the correct gestational age.
19. Salbutamol (Ventolin) should not be used in a patient with:
    • Asthma.
    • Preterm rupture of the membranes.
    • Multiple pregnancy.
    • Heart valve disease.
20. What advice should be given to a patient who had a preterm delivery?
    • If she only had one previous preterm delivery, there is no need to be concerned about future pregnancies.
    • There is a high risk of recurrence, it will be better not to attempt future pregnancies.
    • Intervention is only required if a patient had two previous preterm deliveries.
    • The patient should be seen at a level 2 hospital before her next pregnancy to be assessed for possible causes.