Abnormal high risk labour Flashcards
What must you NOT do once a PROM or PPROM is diagnosed? Why?
Digital vaginal examination
Risk of infection
What does PROM stand for? What does this mean?
premature rupture of membranes - rupture of membranes BEFORE labour
What does PROM stand for?
premature rupture of membranes - before labour
What does PPROM stand for?
preterm PROM
before 37 weeks
when does PPROM occur?
Before 37 weeks
What is different about speculums in PPROM?
THEY ARE STERILE
How do you diagnose PPROM?
Clinical diagnosis
How do you diagnose PPROM?
Clinical diagnosis
Pooling amniotic fluid on sterile speculum
DO NOT PERFORM UNNECCESARY DIGITAL VAGINAL EXAMINATION ONCE DIAGNOSED
How common is PPROM?
8-10% term pregnancies
How common are PROM and PPROM?
PROM: 8-10% term pregnancies
PPROM: 2% of all pregnancies
What investigations would you do for a patient with PPROM?
History
FBC (WCC)
CRP
HVS
MSU
Maternal pulse and temp
CTG
Check pH using nitrazine
Ferning
Placental alpha-microglobulin-1
What is the probability of spontaneous labour after PROM and PPROM?
PROM: 90% within 48 hours
PPROM: 80% within 7 days
How common are PROM and PPROM?
PROM in term pregnancies: 8-10%
PPROM: 2% of all pregnancies
What is the probability of spontaneous labour after PROM and PPROM?
PROM at term: 90% within 48 hours
PPROM: 80% within 7 days
How would you manage a patient with PPROM?
Antibiotics
How would you manage a patient with PPROM?
Antibiotics - erythromycin
What monitoring would you want to do in a patient with PPROM?
growth temp FBC CRP until 34 weeks - when plan to induce labour
At what date in PPROM would you aim to induce labour?
34 weeks
What is the definition of SROM?
Spontaneous rupture of membranes; term usually used at term
What is prolonged SROM?
> 24 hours. Membranes have ruptured, but labour hasn’t started
What is ARM?
artificial rupture of membranes
When is ARM done?
Part of induction or augmentation of labour
To assess amniotic fluid
What is the definition of breech presentation?
in utero fetal position that leads to the buttocks being delivered first.
How often does this happen?
about 3% of pregnancies at term
What are the different classifications of presentation?
frank/extended (65%)
complete/flexed (10%)
incomplete/footling (25%)
What should you do if a baby is found to present as breech?
Examination
US scan
Antenatal management:
external cephalic version
C-section
Vaginal breech delivery
What should you do if a baby is found to present as breech?
Examination
US scan
Antenatal management:
external cephalic version (ECV)
C-section
Vaginal breech delivery
What is external cephalic version?
moving the foetus into position - out of breech and in to the correct position
What is external cephalic version?
moving the foetus into position - out of breech and in to the correct position
Apply gentle pressure
When is ECV offered?
36-37 weeks
What is the success rate of ECV?
35-50%
What are risks of ECV?
Low complication rate
Pain
Transient bradycardia (resolves spontaneously)
Abruptions (<1%)
Prolonged bradycardia
Emergency LSCS
tocolysis (cord wrapped around baby’s neck)
What must you give mothers who are Rh negative? Why?
Anti-D
Risk of veto-maternal haemorrhage
Sensitising event
What are some absolute contra-indications for ECV?
Placenta praaevia
Uterine malformations
Rupture membranes
Abnormal CTG
Multiple pregnancy
What are some absolute contra-indications for ECV?
Placenta praaevia
Uterine malformations
Rupture membranes
Abnormal CTG
Multiple pregnancy
What are some relative contra-indications for ECV?
Previous CS
Active labour
Preeclampsia
Oligohydramnios
Fetal abnormality
Hypertension of fatal heart
Maternal cardiac disease
What are some relative contra-indications for ECV?
Previous CS
Active labour
Preeclampsia
Oligohydramnios
Fetal abnormality
Hypertension of foetal heart
Maternal cardiac disease
What is the main factor determining pregnancy outcome in multi-pregnancies?
Chorionicity
How is chorionicity determined?
How effective is this?
US at 10-14 weeks
100% effective
What is the main factor determining pregnancy outcome in multi-pregnancies?
Chorionicity (whether the babies have separate placentas, chorionic sacs)
What are some maternal complications in multiple pregnancy?
Hyperemesis gravidarum
Anaemia
Miscarriage
Preterm labour and delivery
Gestational diabetes
Pre-eclampsia
Antepartum haemorrhage
Postpartum haemorrhage
Postnatal depression
What are some foetal risks in multiple pregnancy?
Prematurity
Congenital abnormalities: chromosomal, structural eg. cardiac, bowel and neural tube
(2-3 times higher in MZ twins)
Foetal growth restriction
Intrauterine death
Twin-to-twin transfusion syndrome
What is included in multiple pregnancy antenatal care?
USS at 11 - 14 weeks
Oral iron and folic acid 5mg
Detailed anatomy scan and cardiac scans
Regular growth scans:
DCDA 4 weekly (from 24 weeks)
MC twins 2 weekly (from 16 weeks)
Regular BP and urine checks
When does a delivery of DCDA occur?
37-38 weeks
When does MCDA delivery occur?
34-37 weeks
When does MCMA delivery occur? HOW?
34 weeks
CS
If the presenting twin is cephalic, what would the advice be re. mode of delivery?
vaginal delivery recommended
If the presenting twin is cephalic, what would the advice be re. mode of delivery?
vaginal delivery recommended
If the presenting twin is breech/transverse lie, what would the advice be re. mode of delivery?
CS
How regular are the growth scans for DCDA?
4 weekly (from 24 weeks)
How regular are MC twins scanned?
2 weekly (from 16 weeks)
