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Obstetrics > Prematurity, labour and birth > Flashcards

Prematurity, labour and birth Flashcards

(37 cards)

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1
Q

True labour is defined as…

A

Rhythmic regular and increasing contractions with pain and cervical dilation.

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2
Q

List the components of the Bishop score

A 
Dilation
Length
Consistency
Position
Station
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3
Q

Indications for induction of labour

A

Maternal:

  • GDM
  • PET
  • PROM, PPROM
  • maternal request

Foetal:

  • IUGR/SGA
  • dec foetal movements
  • post-term (>42wks)
  • intrauterine foetal death
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4
Q

Contraindications for IOL

A 
Placenta praevia
Vasa praevia
Transverse lie
Cord prolapse
Active maternal genital herpes
Relative CI: VBAC
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5
Q

Methods of IOL

A
  • Membrane sweep
  • Cervical ripening - prostins (prostaglandin gel/pessary) or balloon (Cooks) catheter
  • ARM - only if Bishop score >7. +/- syntocinon
  • Syntocinon (oxytocin)
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6
Q

First stage of labour - Definition and phases

A

From onset of labour to 10cm dilated.

Latent phase:

  • Irregular contractions
  • Until 4-6cm dilated and fully effaced.
  • <1cm/hr dilation
  • manage at home

Active phase:

  • regular contractions
  • 6cm until full dilation
  • > 1cm/hr
  • admit, analgesia, foetal monitoring
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7
Q

Second stage of labour - duration and definition

A

Primi: 2 hrs
Multi: 1 hr

From 10cm dilated until delivery of baby

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8
Q

3rd stage of labour definition and duration

A

Duration <30mins. Avg 6 mins.

From the time the baby is born until the delivery of the placenta

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9
Q

What is active management of the 3rd stage of labour

A

Oxytocin
Delay clamping of the cord (reduced neonatal anaemia)
Controlled cord traction with uterine stabilisation (prevents uterine inversion)

NB: Oxytocin + controlled cord traction halves the rates of PPH.

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10
Q

4th stage of labour: definition and what to look out for

A

Defined as the 6hr post-delivery period.

Watch out for PPH, post-partum eclampsia and check the tone of the uterus.

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11
Q

Features of Braxton Hick’s contractions

A

Common in 2nd and 3rd trimester.
Physiological - helps with foetal positioning.
Irregular, uncoordinated contractions of moderate intensity.
No cervical changes.
Stops with rest, walking or position changes.,

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12
Q

Frequency of contractions in the 2nd stage of labour

A

4 in 10mins

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13
Q

Indications for assisted delivery

A

Prolonged 2nd stage of labour (>2hrs in primi, >1hr in multi and add an hour if epidural).
Breech presentation
Non-reassuring foetal HR
Maternal fatigue

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14
Q

Forcep delivery - advantages and complications

A

Advantages:

  • does not require maternal effort
  • scalp injuries less common than vacuum
  • lower rate of failure than vacuum
Complications:
Maternal
- genital lacerations
- perineal hematoma
- urinary tract and sphincter injury
- need epidural and episiotomy

Foetal:

  • head or soft tissue trauma
  • facial nerve palsy
  • ICH
  • skull #
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15
Q

Vacuum extractor delivery - advantages, disadvantages and complications

A

Advantages:

  • decreases incidence of 3rd and 4th deg tears
  • no analgesia required
  • less space required

Disadvantages:

  • required maternal pushing
  • higher rate of failure

Complications:
Maternal
- genital hematoma/lacerations

Foetal

  • cephalohaematoma, scalp lac
  • ICH
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16
Q

Contraindications for VBAC

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A 
Classical CS scar
Hx uterine rupture
Multiple pregnancy
Placenta praevia
Transverse lie
17
Q

Indications for VBAC

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A

Maternal request if:

  • 1 x prev LSCS
  • singleton pregnancy
  • cephalic presentation
18
Q

Main risk with VBAC

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A 
Uterine rupture (1 in 200) --> maternal haemorrhage, hysterectomy and death. Baby: HIE, death.
Placental abruption (1 in 100)

NB: oxytocin augmentation doubles risk of rupture to 1 in 100
Prostaglandins increase it to 1 in 50.

19
Q

Management principles of VBAC

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A

Avoid induction (balloon and ARM are the least risky).
Continuous CTG.
Analgesia.
No more than 3 hrs of no progress.

20
Q

Definition of term SROM

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A

SROM at >37wks without any signs or symptoms of labour

21
Q

Management of term SROM

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A

Expectant VS IOL.

Expectant:
Criteria = All healthy women (GBS -ve, no signs of infection, clear liquor, normral CTG).
Watch and wait.
If no labour after 18hrs –> abx (clindamycin or ben pen)
If no labour after 24hrs –> IOL with oxytocin.

IOL:
Done immediately if GBS +ve woman.
Use oxytocin.

22
Q

PROM and PPROM - definition

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A

PROM = Prelabour ROM at or beyond 37 wks gestation with failure to establish labour 4 hrs after ROM.

PPROM = ROM at <37wks.

23
Q

What is pre-viable PPROM

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A

PPROM at <23wks

No resus due to pulmonary hypoplasia ad inevitable foetal demise.

24
Q

Risk factors for PPROM and PROM

Study These Flashcards
A 
Chorioamnionitis
UTI
APH
Polyhydramnios
Smoker
Multiple pregnancy
Amniocentesis
External cephalic version
25
Investigations for PPROM and PROM
Confirm it's amniotic fluid: - Amnisure (alpha microglobulin protein) - pH stick (Nitrazine) - Actimprom Low vaginal swab for GBS Urinalysis and urine MCS Pelvic US (liquor volume, cervical length)
26
PPROM and PROM management
``` Admit to ward (50% will deliver within 24 hrs) Maternal obs Foetal obs Steroids Abx: erythromycin for chorio prevention Timing of delivery -Term: IOL or expectant - Preterm: safe to wait until 37 wks (weekly ANC review, monitor temp at home) -Sepsis: deliver immediately ```
27
Complications of PPROM and PROM
Maternal: - cord prolapse - cord compression - maternal infection - chorioamnionitis Foetal: - sepsis - death - lung hypoplasia - foetal hypoxia - periventricular leukomalacia --> cerebral palsy
28
Define pre-term labour
Onset of regular and painful contractions with effacement and dilation of the cervix at between 20-37wks gestation.
29
Survival rates of preterm birth
After 23wks --> 20% survival | After 31wks --> 90% survival
30
Aetiology of preterm birth
Most common: PROM, chorioamnionitis, UTI. Stress (mental or physical) - maternal stress --> cortisol --> trigger of labour - Foetal stress (hypoxia) - intercurrent illness Infection - chorioamnionitis - UTI - BV Placental abruption - uterus will contract to clamp off the bleeding BVs Uterine/cervical abnormality - uterine distention in multiple pregnancy or polyhydramnios (tricks uterus into thinking that the pregnancy is further along than it is) - cervical insufficiency
31
Risk factors for preterm labour
``` Previous preterm delivery (biggest Rx Fx) Smoking and drug use Multiple pregnancy Polyhydramnios PPROM PET Previous cervical surgery UTI, genital tract infections Extremes of maternal age ```
32
Diagnosis of preterm labour
Sterile speculum exam: - pooling of amniotic fluid - swab post fornix for foetal fibronectin (FFN is the glue that holds the amnion to the decida. Disruption of interface --> release of FFN into vaginal secretions) TVUS (measure cervical length) Mid-stream urine MCS High vaginal swab MCS
33
Management of a woman in preterm labour
Corticosteroids (betamethasone or dexamethasone) if <34wks Tocolysis - delays births to give the steroids time to work - 1: nifedipine (SM relaxant) - 2: beta agonists (salbutamol) - 3: Prostaglandin synthase inhibitors (indomethacin) Magnesium sulfate - if birth is imminent at <30 wks - neuroprotective against cerebral palsy ABX if PPROM or infection
34
Management of asymptomatic women at high risk of preterm labour
Screen for genitourinary infections and treat them (UTI, BV). Smoking cessation Monitor cervical length from 16wks Vaginal progesterone or cervical cerclage.
35
Risks of preterm birth
Child: - neonatal death - cerebral palsy - hearing impairment - visual impairment (retinopathy of prematurity, hypermetropia, myopia) - cognitive impairment, ADHD, dyslexia - chronic lung disease - inc risk non-communicable disease (asthma) Mother: - recurrent PTL - IHD, stroke
36
WHO recommendations for improving outcomes of preterm birth
4-1-4 Intrapartum - 4 drugs: 1. Tocolysis 2. Steroids from 24-34wks 3. Magnesium sulfate if <32 wks 4. Erythromycin if PPROM or infection Delivery: 6. Routine CS not recommended Post-partum - breathing support: 5. Kangaroo care (skin on skin) 7. CPAP for respiratory distress syndrome 8. Surfactant replacement for RDS 9. O2 therapy starting at 30%
37
Indications for caesarean section
Maternal: - elective - failure to progress in 2nd stage labour - placenta praevia - repeat CS - APH Foetal: - Non-reassuring CTG - malpresentation - cord prolapse - multiple pregnancy

Obstetrics (7 decks)

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