TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Preterm labour          TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions View previous topic :: View next topic   Author Message mrcog2010 Joined: 08 Jul 2008 Posts: 32 Posted: Fri Sep 05, 2008 12:22 pm    Post subject: the following are associated with 'spontaneous' preterm delivery: breech F uterine abnormality T diabetes T twins T CAN WE DISCUSS PLZ ? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Sep 06, 2008 3:49 pm    Post subject: rpwalavalkar wrote: Quote: the following are associated with 'spontaneous' preterm delivery: breech uterine abnormality diabetes twins Uterine abnormality -- True when associated with cervical incompetence and in bicornuate uterus. Diabetes -- True contributing factors - macrosomia, polyhydramnios Twins -- true Known association Breech -- unsure. my first thought was false. r Back to top mrcog2010 Joined: 08 Jul 2008 Posts: 32 Posted: Sat Sep 06, 2008 5:32 pm    Post subject: thanks nick Back to top Maud Joined: 11 Oct 2007 Posts: 73 Location: Bristol Posted: Sat Sep 06, 2008 7:36 pm    Post subject: I said true for breech, as breech is more common in prematurity and therefore also in premature labour. I said false with diabetes, cause thought prematurity was more common because of iatrogenic causes (e/l section or induction). I did consider saying true because of polyhydramnios, but wasn't sure whether that was a "second cousin". This is why I hate mcq's, there's no chance to explain your thought process and having it wrong gives you as little points as someone who is just guessing it wrong Back to top mrcog2010 Joined: 08 Jul 2008 Posts: 32 Posted: Sat Sep 06, 2008 7:46 pm    Post subject: I Think there is a differance between preterm and premature Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sun Sep 07, 2008 10:25 am    Post subject: Breech False - not spontaneous. The relationship with preterm delivery is different - if you deliver prematurely the presentation is more likely to be breech but breech, per se, does not predispose to preterm delivery. uterine abnormality True - clear but often debated relationship. The RCOG do say anomalies are related to cervical incompetence but I am less sure. The relationship persists even for minor defects such as an arcuate uterus. diabetes False - poorly controlled may lead to polyhydramnios and then spontaneous PTL but not diabetes alone hence the need for induction in so many cases. twins True - straightforward and proportionate to the 'n' i.e. higher with triplets and so on. Also higher for monoamniotic twins I believe as the incidence of TTS is increased. I wonder what proportion of preterm triplets are spontaneous and iatrogenic? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sun Sep 07, 2008 10:32 am    Post subject: mrcog2010 wrote: I Think there is a differance between preterm and premature I do not think so mrcog2010 - they are synonymous in my opinion. Both refer to birth before the 37th completed week. We can further subdivide into very preterm and extreme prematurity as we do with birthweight: Birthweight - LBW < 2500g - VLBW <1500g - XLBW < 1000g These weights roughly equate with birth at or below 37 weeks, 32 weeks, and 28 weeks respectively (at least I think so - I am recalling this from my 6 months elective in neonates). Not sure I have ever seen a subdivision of PTL but that would be my suggestion. Remember gestational age is a more important predictor of outcome than birthweight (Epicure study). 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