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Complications in Delivery Flashcards

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1
Q

A baby is born prematurely if it is delivered before what gestation?

A

37 weeks

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2
Q

What is the usual gestation and birthweight of viability of a foetus?

A

24 weeks, > 500g

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3
Q

What is the strongest risk factor for preterm delivery?

A

Previous preterm delivery

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4
Q

What is the main complication of PPROM for the mother?

A

Chorioamnionitis

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5
Q

Pooling of amniotic fluid in the posterior vaginal vault on speculum examination is suggestive of what diagnosis?

A

PPROM

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6
Q

Should you perform a digital vaginal examination in a woman with PPROM?

A

No

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7
Q

What may an ultrasound scan of a woman with PPROM show?

A

Oligohydramnios

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8
Q

How is PPROM managed medically?

A

10 day course of erythromycin and also give corticosteroids

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9
Q

At what gestation should delivery be considered in women with PPROM?

A

34 weeks

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10
Q

To assess the likelihood of preterm delivery in women who are deemed to be high risk, ultrasound is used to measure what?

A

Cervical length

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11
Q

Women with a cervical length of less than what are at higher risk of preterm birth?

A

25mm

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12
Q

What procedure can be used in women who have a high-risk of premature delivery to reduce the risk of this occurring?

A

Cervical suture (cerclage)

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13
Q

If an abdominal suture is inserted in a woman who is very high risk of premature delivery, how must the baby then be delivered?

A

C-section

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14
Q

If a woman presents with painful contractions and backache suggestive of premature labour, combined with PV bleeding, what is likely the event that triggered the labour?

A

Antepartum haemorrhage

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15
Q

If a woman presents with painful contractions and backache suggestive of premature labour, combined with loss of fluid vaginally, what is likely the event that triggered the labour?

A

PPROM

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16
Q

Premature labour can be diagnosed by examination alone once what is seen?

A

Cervical dilation > 3cm

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17
Q

The fibronectin or Actim Partus tests can be used to assess the likelihood of what complication?

A

Preterm delivery

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18
Q

In cases of suspected preterm labour, what investigations should be carried out to screen for infection?

A

Urine sample and vaginal swabs

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19
Q

After PPROM, what investigations are carried out to monitor for infection?

A

FBC and CRP

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20
Q

What is the aim of management of preterm labour?

A

To delay delivery to allow administration of corticosteroids and transfer to hospital

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21
Q

Via what route are corticosteroids given to women in preterm labour?

A

IM

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22
Q

The beneficial effects of maternal corticosteroids are apparent if the baby is born how long after the second dose? How long do the effects of the steroids last for?

A

24 hours / 7 days

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23
Q

What medications can be used in women in preterm labour to inhibit contractions and delay delivery?

A

Tocolytics

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24
Q

What is the commonest malpresentation at labour?

A

Breech presentation

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25
For which malpresentations of the foetus is a vaginal delivery possible?
Breech and face presentations
26
For which malpresentations of the foetus is a vaginal delivery not possible?
Shoulder and brow presentations
27
If malpresentation of the foetus is suspected clinically, this can be confirmed with which investigation?
Ultrasound
28
What is the first line management option for malpresentation of the foetus?
External cephalic version
29
Is perinatal morbidity and mortality higher with a vaginal breech delivery or a C-section?
Vaginal breech delivery
30
A delay in the active phase of the first stage of labour would be suspected if there was less than how much change in cervical dilatation in a four hour period?
< 2cm
31
A delay in the active phase of the first stage of labour is confirmed if there is no change in cervical dilatation how long after artificial rupture of membranes?
2 hours
32
What position decreases the efficiency of uterine contractions during labour?
Supine
33
Failure to progress in labour is always due to a problem with at least one of what three things?
Power, passage or passenger
34
How are the frequency and strength of uterine contractions determined in labour in a woman with failure to progress?
Abdominal palpation
35
How is the foetal size, presentation and position assessed in labour in a woman with failure to progress?
Abdominal palpation and vaginal examination
36
If clinical examination is unhelpful, what investigation can be used to determine the foetal presentation?
Ultrasound
37
What positions are best for increasing pelvic outlet dimensions in a woman with failure to progress?
Sitting/squatting
38
What is the first line management option for women with suspected failure to progress in labour, with intact membranes?
Artificial rupture of membranes
39
If failure to progress in labour is confirmed, what is the first line medical management?
IV syntocinon
40
When giving IV syntocinon for failure to progress in labour, the dose should be up-titrated every 30 minutes until the frequency of contractions is what?
4-5 in 10 minutes
41
What is the major concern with the use of syntocinon, particularly in the second stage of labour?
Risk of uterine hyperstimulation
42
Vaginal examination is done 4 hours after starting oxytocin for failure to progress in labour. If cervical dilatation has not increased by 2cm, what is the management plan?
C-section delivery
43
What is the management option for a delay in the second stage of labour where the foetal head is below station 0?
Operative vaginal delivery
44
Antibiotic prophylaxis is given after manual removal of the placenta to prevent against what complication?
Endometritis
45
What are the two main features of foetal distress?
Changes in the foetal heart rate on CTG and passage of meconium
46
Would sign would make you consider there had been passage of meconium in utero?
Green/brown amniotic fluid
47
What investigation is carried out next when a CTG is found to be pathological?
Foetal blood sampling
48
What would be the appropriate management for foetal distress with a lactate of 4.1 or less, and a pH of 7.25 or more?
Repeat foetal blood sample in one hour if CTG abnormalities persist
49
What would be the appropriate management for foetal distress with a lactate of 4.2-4.8 and a pH of 7.21-7.24?
Repeat foetal blood sample in 30 minutes if CTG abnormalities persist
50
What would be the appropriate management for foetal distress with a lactate of 4.9 or more and a pH of 7.2 or less?
Urgent delivery
51
What would be the correct management of a woman with meconium stained liquor before labour?
Immediate induction of labour
52
Which type of operative vaginal delivery causes more perineal trauma?
Forceps
53
Which type of operative vaginal delivery is most likely to be successful?
Forceps
54
Which type of operative vaginal delivery is more likely to cause neonatal cephalohaematoma and retinal haemorrhage?
Ventouse
55
What procedure is done alongside 90% of cases of operative vaginal delivery?
Episiotomy
56
Which type of operative vaginal delivery is more likely to leave temporary marks on the baby's head, and may rarely cause facial nerve palsies?
Forceps
57
Which type of operative vaginal delivery is more likely to cause a chignon (a swelling on the babies head)? How soon does this usually resolve?
Ventouse - within 48 hours
58
What is the most common reason for an elective C-section?
Previous C-section
59
What are the 3 main indications for an emergency C section?
Foetal compromise, failure to progress despite syntocinon and cord prolapse
60
Elective C-sections are usually done after what gestation?
39 weeks
61
C-sections are associated with an increased risk of what respiratory complication in the newborn?
Transient tachypnoea of the newborn
62
Within how long should an emergency (category 1) C-section be performed?
30 minutes
63
What diagnosis should be suspected when there is a sudden decrease in foetal heart rate after rupture of membranes?
Cord prolapse
64
What is the immediate management for a cord prolapse?
Elevate the foetal presenting part (to stop cord compression)
65
What is the definitive management of cord prolapse?
Immediate delivery, usually via a C-section
66
What diagnosis should be considered when the foetal body fails to deliver with axial traction after delivery of the foetal head?
Shoulder dystocia
67
What are the major risk factors for shoulder dystocia?
Foetal macrosomia and maternal diabetes, and instrumental delivery
68
Poor management of shoulder dystocia and pressure applied to the foetal neck can lead to what complication?
Foetal brachial plexus injury
69
Why may an episiotomy be done in the management of shoulder dystocia?
To create more room for internal manoeuvres
70
What is usually the first line manoeuvre for the management of shoulder dystocia?
McRoberts manoeuvre (hyper-flexed legs)
71
What structures are involved in a 1st degree perineal tear?
Perineal skin only
72
What structures are involved in a 2nd degree perineal tear?
Perineal skin and muscle
73
A perineal tear involving < 50% of the external anal sphincter would be classified as what degree?
3A
74
A perineal tear involving > 50% of the external anal sphincter would be classified as what degree?
3B
75
A perineal tear involving the internal anal sphincter would be classified as what degree?
3C
76
What structures are involved in a 4th degree perineal tear?
Internal and external anal sphincters, as well as anal epithelium
77
When may an episiotomy be carried out?
Cases of foetal compromise and instrumental deliveries
78
An episiotomy should be carried out at what point in labour?
Crowning

Obs & Gynae (Obs) (10 decks)

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