2. A woman comes to the emergency at 32 weeks gestation, with complaint of labor pains. On examination, there are a few uterine tightenings. The ultrasound machine is unavailable. What is the sequence of the steps you will take to diagnose preterm labor?
A. Vaginal exam to look for cervical Dilatation
B. Speculum examination for cervical dilatation
C. Fetal fibronectin test
In this patient, on speculum exam- cervical dilation cannot be seen clearly.
Offer a clinical assessment to women reporting symptoms of preterm labour who have intact membranes. This should include:
•clinical history taking
•the observations described for the initial assessment of a woman in labour
•a speculum examination (followed by a digital vaginal examination if the extent of cervical dilatation cannot be assessed; be aware that if a swab for fetal fibronectin testing is anticipated , the swab should be taken before any digital vaginal examination.).
Fetal fibronectin is an adhesive glycoprotein that holds the membranes of the uterus to the fetal membranes. After 35Â weeks of pregnancy, it begins to break down naturally, and is detectable in vaginal secretions. Fetal fibronectin detected between 22Â and 35Â weeks of pregnancy is an indicator of preterm birth risk.
