Foetal positions and Emergency childbirth

Question 1

Definition of Premature rupture of membranes (PROM) in Pregnancy

Answer 1

rupture of membranes before labour starts, at ≥37 weeks gestation

Question 2

Define preterm Premature rupture of membranes (PPROM)

Answer 2

rupture of membranes occurs < 37 weeks

Question 3

Common risk factors for PROM & PPROM

Answer 3

Smoking
Genital tract infection
Vaginal bleeding
Multiple pregnancy
Polyhydramnios
Cervical insufficiency
Invasive uterine procedures

Question 4

PPROM & PROM Sx

Answer 4

• Sudden gush or continuous leakage of clear or pale fluid
• No contractions at onset

Question 5

PROM complications

Answer 5

• Chorioamnionitis: infection of the amnionic membreane
• Cord prolapse
• Labour onset

Question 6

PPROM complications

Answer 6

• Higher risk of chorioamnionitis
• preterm labour
• fetal complications

Question 7

Is amniotic fluid is alkaline or acidic

Answer 7

alkaline

Question 8

what colour does the amniotic fluid turn the pH papar into

Answer 8

blue

Question 9

what is External Cephalic Version (ECV)?

Answer 9

A hands-on procedure to turn foetus from breech or tranverse posistion into cephalic position before labour starts

Question 10

when is ECV ususally performed for primip

Answer 10

after 36 weeks

Question 11

when is ECV performed in multips

Answer 11

after 37 weeks

Question 12

ECV contraindications

Answer 12

• Fetal stress
• Ruptured membranes
• Planned caesarean
• Recent Antepartum Haemorrhage
• Uterine abnormalities

Question 13

What is The Bishop Score used for

Answer 13

The Bishop score is a pre-labour scoring system used to assess the readiness of the cervix for induction and predict the likelihood of successful vaginal delivery

Question 14

What is the maximum total score for the Bisop score

Answer 14

13

Question 15

At what Bishop score is favourable for induction/vaginal delivery

Answer 15

≥ 8 (prostaglandins or oxytoins)

Question 16

At what Bishop score is unfavourable for induction/vaginal delivery

Answer 16

< 6 (cervical ripening technique required) membrane sweep, balloon catheter, aminotomy

Question 17

Define Dystocia

Answer 17

abnormal or difficult labour

Question 18

Define shoulder dystocia

Answer 18

Failure to deliver the fetal shoulders with gentle downward traction after the head has delivered, due to impaction of the shoulder(s)

Question 19

Shoulder Dystocia recognition

Answer 19

“turtle sign” - retraction of the fetal head

Question 20

Risk factors for shoulder dystocia

Answer 20

• Gestational DM
• Fetal macrosomia
• Post-term labour
• Prolonged 2nd stage of labour
• Maternal obesity
• Hx of shoulder dystocia
• Induction of labour

Question 21

Shoulder dystocia complications

Answer 21

Maternal: postpartum haemorrhage, Tears
Fetal: hypoxia, nerve injury, fractures

Question 22

Outline the Shoulder Dystocia Mx

Answer 22

1. Call for help (obstetric, anaesthetic, paediatric teams).
2. McRoberts’ manoeuvre (hyperflex maternal hips onto abdomen).
3. Suprapubic pressure (apply downward pressure above pubic bone).
4. Episiotomy (if needed to facilitate internal manoeuvres).
5. Internal rotational manoeuvres (e.g., Rubin II, Woods screw).

Question 23

Define operative vaginal delivery

Answer 23

The use of instruments (forceps or vacuum/ventouse) to assist vaginal delivery of the fetus during the second stage of labour, usually when there is delay in descent, fetal distress, or maternal exhaustion.

Question 24

Most common operative vaginal delivery

Answer 24

Forceps
Vacuum Extraction

Question 25

At what stage of labour is operative vaginal delivery performed

Answer 25

2nd stage of labour

Question 26

Operative vaginal delivery indications

Answer 26

- Maternal exhaustion - Pronlonged 2nd stage of labour - Fetal distress

Question 27

What Abx is used as a prophylaxis for ascending genital infection in PPROM

Answer 27

Macrolides: Erythromycin / clindamycin

Question 28

Gold standard Ix for PPROM

Answer 28

Sterile speculum examination