OG13.4 | Preterm Labour, PROM and Post-Dated Pregnancy — Summary & Reflection

KEY TAKEAWAYS

Preterm labour (<37 weeks) is defined by contractions plus cervical change; causes include infection, PPROM, uterine overdistension, abruption, and cervical incompetence. PROM is membrane rupture before labour; PPROM is PROM <37 weeks, confirmed by speculum (pooling, ferning, pH, AmniSure) — digital examination contraindicated. Post-dated pregnancy (≥42 weeks) carries rising stillbirth risk from uteroplacental insufficiency. Management of preterm labour: tocolysis (nifedipine first-line; atosiban alternative; beta-2 agonists short-term; indomethacin <32 weeks); antenatal corticosteroids (betamethasone 12 mg IM × 2 doses, 24 h apart, window 24–34 weeks); magnesium sulphate for neuroprotection <32 weeks (Zuspan: 4 g IV + 1 g/h; NOT for tocolysis; antidote = calcium gluconate 1 g IV); GBS prophylaxis (penicillin G). Management of PPROM: term — induce within 12–24 h; <34 weeks — expectant + erythromycin (NOT co-amoxiclav — NEC risk) + steroids + GBS prophylaxis. Post-dates: offer induction at 41 weeks, mandate by 42 weeks; surveillance with CTG, BPP, AFI.

REFLECT

Think about the 28-week patient in the hook scenario. You now know the four-drug protocol, the gestational windows, and the contraindications. What would you have done differently at 11 PM before you had this knowledge? What would you do now? More importantly — when you are on call at 3 AM and a preterm labour patient arrives, these drug names and doses need to be immediately accessible in your mind. Kolb's model asks you to move from concrete experience (a clinical scenario) through reflection and conceptualisation to active experimentation. Your task now is to write out — from memory — the four components of the preterm labour protocol at 28–32 weeks, with doses, and check your recall against the summary above. That act of retrieval practice is the most efficient way to move this knowledge from short-term review to long-term clinical memory.