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Obstretics > Labour > Flashcards

Labour Flashcards

1
Q

Maternal Causes of preterm labour

A

PPROM, uterine stretch, cervical insufficiency, APH, infection, trauma, IOL

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2
Q

Fetal causes of preterm labour

A

IUGR, aneuploidy, structural malformations

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3
Q

Risks of giving oxytocin to induce labour

A

Uterine hyper stimulation, amniotic fluid embolism, water intoxication

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4
Q

When to do fetal fibronectin?

A

When cervix <3cm dilated, not in active labour, not ROM

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5
Q

How to diagnose preterm labour?

A

If regular, powerful contractions
Cervix is dilated to 4 or more cm
Or cervical dilation

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6
Q

Causes of OP position

A
  1. Android/anthropoid type pelvis

2. Use of intrapartum epidural analgesia due to relaxation of the pelvic floor muscles - it can’t rotate anteriorly

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7
Q

How to manage OP position in labour?

A
  1. Closely monitor progress and fetus (CTG)
  2. Use oxytocin to maintain 3-4 contractions every 10 minutes, will help rotation to OA
  3. Can use instrumental delivery
  4. If failure to progress/CTG abnormality, C section needed
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8
Q

What to do when you diagnose TAPS?

A

Follow up for MCA PSV within 24 hours

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9
Q

Maternal risks in multiple pregnancy (antenatal)

A

IDA, backache, GERD, hyperemesis gravidarum
APH, preeclampsia, GDM, GHTN, miscarriage
PPROM, preterm labour

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10
Q

Maternal risks multiple pregnancy (intra and postpartum)

A

Operative delivery, cord prolapse, PPH, postpartum depression

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11
Q

What are the antibiotics given for PPROM?

A
  1. Erythromycin 250MG PO QID for 10 days/till labour starts

2. Ampicillin 2g IV 6hrly for 2 days, then amoxicillin 250mg PO TDS for 5 days + erythromycin as above

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12
Q

When to do active management for PROM?

A

GBS +ve, SROM > 96 hours, meconium staining, chorioamnionitis, abnormal CTG, breech/malpresentation, multiple pregnancy

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13
Q

Definition of macrosomia

A

Above 90th percentile/4.5kg (Aussie)

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14
Q

When can you use low/mid cavity forceps

A

Fetal head 1/5th palpable per abdomen
Leading point of skull is above station + 2cm but NOT above ischial spines
Rotation of 45 or less

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15
Q

Postnatal care for instrumental delivery

A 
Prophylactic antibiotics 
Thromboprophylaxis 
Analgesia 
Indwelling catheter for 12 hours
Pelvic floor exercises
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16
Q

Early and intermediate risks for C-section

A 
Maternal 
- PPH
- damage to bowel, bladder, ureters 
- anesthesia
- wound hematoma 
Fetal
- TTN
- laceration

Intermediate

  • infection
  • VTE
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17
Q

Late risks for C-section

A 
Urogenital fistula 
Adhesion
Uterine rupture with subsequent prev
Placental malpositioning
Ectopic pregnancy
Repeat C-section for subsequent pregnancy
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18
Q

How to diagnose PPROM/PROM

A

Sterile speculum

  • pooling of amniotic fluid
  • if not, do ActimProm
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19
Q

Investigations for PPROM/PROM

A

Vital signs
FBC, CRP
First-void urine for chlamydia and gonorrhea PCR
MSU for MC&S
Low vaginal and perianal swab if GBS unknown

20
Q

Ongoing maternal and fetal surveillance PPROM

A

Maternal
- 4-6 hourly temperature and pulse
- vaginal loss and uterine activity
- WCC 2x a week
- blood culture if chorio suspected, expedite birth
- woman must notify staff if feeling unwell, foul discharge, abdominal pain, change in fetal movements
Fetal
- CTG if more than 28 weeks, daily for 3 days then twice weekly
- BPP if less than 28 weeks, same

21
Q

Birth timing in PPROM

A

All women expedite at 37 weeks, expectant if less.

If chorio or compromise, hasten

22
Q

Intrapartum management of PPROM

A

If GBS, treat accordingly
Continuous CTG
Neonataology/paeds attend birth
Sent placenta and swabs for HPE

23
Q

PPROM management flow

A 
History 
Diagnosis 
Investigations
Antibiotics
CS/MGSO4
Ongoing surveillance
Outpatient 
Birth timing
Intrapartum mx 
Postnatal observation
24
Q

When can discharge PPROM and indications

A

After admitted for 3 days, if got access to hospital, support at home, no signs of labour, no infection, no risk factors, no fetal compromise, gestational age

25
Expectant management for PROM
Book IOL within 96 hours after SROM or earlier if woman chooses LVS and perianal swab for GBS if required Review as outpatient every 48 hours - CTG - maternal vitals - vaginal loss, abdominal pain and tenderness If spontaneous labour, CTG at 24 hours after SROM
26
Bishop’s score cervical dilation and length scoring
0: 0cm/3 1: 1-2cm/2 2: 3-4cm/1 3: 5+/0
27
Bishop’s score cervical length scoring
0: 3cm 1: 2cm 2: 1cm 3: 0cm
28
Bishop’s score station scoring
0: -3 1: -2 2: -1,0 3: +1 onwards
29
Bishop’s score cervical consistency scoring
0: firm 1: medium 2: soft
30
Bishop’s score cervical position
0: posterior 1: mid 2; anterior
31
Contraindications to using vaginal pessary or vaginal gel to IOL
Multiparity > 3, unexplained vaginas bleeding, fetal compromise, previous c-section, major uterus surgery, asthma, hypersensitivity to PGE
32
Risks of using PGE2 for IOL
Uterine hyperstimulation, GI upset, uterine rupture, placenta abruptio
33
Which is the recommended episiotomy
Mediolateral at 60 angle to midline
34
Which sphincter injury causes fecal urgency and which causes fecal incontinence
External Internal
35
Antenatal management of multiple pregnancy
High dose folate supplement and iron! 11-13 weeks: dating scan to determine chorionicity and assign nomenclature to fetus, as usual with others 20-22 week: anatomy scan MCDA: fortnightly ultrasound from 16 weeks to monitor for TTTS and sFGR DCDA: monthly scan from 24 weeks Visits - monthly till 30 weeks - fortnightly till 34 - weekly after 34
36
Delivery timing and mode
DCDA: 37-38 weeks MCDA: 36-37 (need betamethasone) MCMA: 32-34 ``` DCDA and MCDA: - vaginal of presenting twin cephalic, no complications, no size difference - epidural in case need IPV for breech - mom can choose c section MCMA: always c section Triplets and above: always c section ```
37
Monochorionic twins risk
1. Twin-twin transfusion syndrome (TTTS) - placenta laser ablation to disrupt anastomosis - serial amnioreduction every 1-2 weeks 2. Twin reversed arterial perfusion sequence (TRAPS) - cord ligation 3. Selective FGR 4. Twin anemia-polycythemia sequence (TAPS) - need to follow up with u/s for MCA PSV within 24 hours once detected MCMA: cord entanglement (need to deliver early by c-section)
38
Maternal risks of multiple pregnancy
Antenatal: IDA, GERD, backache, hyperemesis gravidarum APH, GHTN, preeclampsia, GDM, miscarriage Intrapartum and postpartum: PROM, preterm labour, operative delivery, cord prolapse PPH, breastfeeding, postpartum depression
39
Contraindications to vacuum delivery
Relative - fetal bleeding disorders - predisposition to fracture Absolute - <34 weeks due to risk of ICH - face presentation
40
Outlet forceps (Wrigley’s) indications
fetal scalp visible without separating labia fetal skull reached pelvic floor rotation does not exceed 45 fetal head at or on perineum
41
Low/mid cavity forceps aka Neville Barnes, Anderson, Simpson
fetal head one-fifth palpable per abdomen leading point of skill is above station + 2cm but not above ischial spines rotation 45 or less
42
When to admit for preterm labour
Admit if: fFn 50ng/ml or more Cervical dilation/change after 2-4 hours, cervix length <15 mm ROM/regular painful contraction/other concern
43
When is tocolysis needed for preterm labour and what are they
If risk of birth within 7 days, to allow for CS administration or if need transfer Nifedipine, salbutamol, indomethacin
44
When to discharge if threatened preterm labour and when to follow-up
``` Normal maternal vitals No chorioamnionitis Infrequent contractions No cervical change Normal CTG FFN negative ``` must follow-up in one week and tell signs of PTL, risk reduction, how and when to seek clinical advice
45
Contraindications for ECV
``` Maternal: previous scar, high-risk mom Placenta: previa Fetal: IUGR, malformation, multiple preg, footling breech Fetomaternal: Rh incompatibility ROM Abnormal CTG ```
46
Procedure for breech
Admit mother and perform examination and investigations Maternal: FBC, ECG, blood group, rhesus Fetal: CTG, USG, amniotic fluid vol NBM Don’t empty bladder Administer tocolytics - SC terbutaline 250microgram or nifedipine 20mg oral During: - feel slight discomfort - monitor FHR a intermittently After - Kleihauer - give anti-D IgG - perform CTG: if abnormal, PV bleed, unexplained pain, expedite birth - if successful, monitor for a day - come back for abdominal USG after a week
47
What maneuver is performed in breech delivery
Lovset’s

Obstretics (8 decks)

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