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GOSH > Abnormal high risk labour > Flashcards

Abnormal high risk labour Flashcards

1
Q

What must you NOT do once a PROM or PPROM is diagnosed? Why?

A

Digital vaginal examination

Risk of infection

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2
Q

What does PROM stand for? What does this mean?

A

premature rupture of membranes - rupture of membranes BEFORE labour

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3
Q

What does PROM stand for?

A

premature rupture of membranes - before labour

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4
Q

What does PPROM stand for?

A

preterm PROM

before 37 weeks

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5
Q

when does PPROM occur?

A

Before 37 weeks

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6
Q

What is different about speculums in PPROM?

A

THEY ARE STERILE

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7
Q

How do you diagnose PPROM?

A

Clinical diagnosis

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8
Q

How do you diagnose PPROM?

A

Clinical diagnosis

Pooling amniotic fluid on sterile speculum

DO NOT PERFORM UNNECCESARY DIGITAL VAGINAL EXAMINATION ONCE DIAGNOSED

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9
Q

How common is PPROM?

A

8-10% term pregnancies

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10
Q

How common are PROM and PPROM?

A

PROM: 8-10% term pregnancies

PPROM: 2% of all pregnancies

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11
Q

What investigations would you do for a patient with PPROM?

A

History

FBC (WCC)
CRP
HVS
MSU

Maternal pulse and temp

CTG

Check pH using nitrazine

Ferning
Placental alpha-microglobulin-1

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12
Q

What is the probability of spontaneous labour after PROM and PPROM?

A

PROM: 90% within 48 hours

PPROM: 80% within 7 days

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13
Q

How common are PROM and PPROM?

A

PROM in term pregnancies: 8-10%

PPROM: 2% of all pregnancies

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14
Q

What is the probability of spontaneous labour after PROM and PPROM?

A

PROM at term: 90% within 48 hours

PPROM: 80% within 7 days

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15
Q

How would you manage a patient with PPROM?

A

Antibiotics

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16
Q

How would you manage a patient with PPROM?

A

Antibiotics - erythromycin

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17
Q

What monitoring would you want to do in a patient with PPROM?

A 
growth
temp
FBC
CRP
until 34 weeks - when plan to induce labour
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18
Q

At what date in PPROM would you aim to induce labour?

A

34 weeks

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19
Q

What is the definition of SROM?

A

Spontaneous rupture of membranes; term usually used at term

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20
Q

What is prolonged SROM?

A

> 24 hours. Membranes have ruptured, but labour hasn’t started

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21
Q

What is ARM?

A

artificial rupture of membranes

22
Q

When is ARM done?

A

Part of induction or augmentation of labour

To assess amniotic fluid

23
Q

What is the definition of breech presentation?

A

in utero fetal position that leads to the buttocks being delivered first.

24
Q

How often does this happen?

A

about 3% of pregnancies at term

25
Q

What are the different classifications of presentation?

A

frank/extended (65%)

complete/flexed (10%)

incomplete/footling (25%)

26
Q

What should you do if a baby is found to present as breech?

A

Examination

US scan

Antenatal management:
external cephalic version
C-section
Vaginal breech delivery

27
Q

What should you do if a baby is found to present as breech?

A

Examination

US scan

Antenatal management:
external cephalic version (ECV)
C-section
Vaginal breech delivery

28
Q

What is external cephalic version?

A

moving the foetus into position - out of breech and in to the correct position

29
Q

What is external cephalic version?

A

moving the foetus into position - out of breech and in to the correct position

Apply gentle pressure

30
Q

When is ECV offered?

A

36-37 weeks

31
Q

What is the success rate of ECV?

A

35-50%

32
Q

What are risks of ECV?

A

Low complication rate

Pain

Transient bradycardia (resolves spontaneously)

Abruptions (<1%)

Prolonged bradycardia

Emergency LSCS

tocolysis (cord wrapped around baby’s neck)

33
Q

What must you give mothers who are Rh negative? Why?

A

Anti-D

Risk of veto-maternal haemorrhage

Sensitising event

34
Q

What are some absolute contra-indications for ECV?

A

Placenta praaevia

Uterine malformations

Rupture membranes

Abnormal CTG

Multiple pregnancy

35
Q

What are some absolute contra-indications for ECV?

A

Placenta praaevia

Uterine malformations

Rupture membranes

Abnormal CTG

Multiple pregnancy

36
Q

What are some relative contra-indications for ECV?

A

Previous CS

Active labour

Preeclampsia

Oligohydramnios

Fetal abnormality

Hypertension of fatal heart

Maternal cardiac disease

37
Q

What are some relative contra-indications for ECV?

A

Previous CS

Active labour

Preeclampsia

Oligohydramnios

Fetal abnormality

Hypertension of foetal heart

Maternal cardiac disease

38
Q

What is the main factor determining pregnancy outcome in multi-pregnancies?

A

Chorionicity

39
Q

How is chorionicity determined?

How effective is this?

A

US at 10-14 weeks

100% effective

40
Q

What is the main factor determining pregnancy outcome in multi-pregnancies?

A

Chorionicity (whether the babies have separate placentas, chorionic sacs)

41
Q

What are some maternal complications in multiple pregnancy?

A

Hyperemesis gravidarum

Anaemia

Miscarriage

Preterm labour and delivery

Gestational diabetes

Pre-eclampsia

Antepartum haemorrhage

Postpartum haemorrhage

Postnatal depression

42
Q

What are some foetal risks in multiple pregnancy?

A

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

43
Q

What is included in multiple pregnancy antenatal care?

A

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

44
Q

When does a delivery of DCDA occur?

A

37-38 weeks

45
Q

When does MCDA delivery occur?

A

34-37 weeks

46
Q

When does MCMA delivery occur? HOW?

A

34 weeks

CS

47
Q

If the presenting twin is cephalic, what would the advice be re. mode of delivery?

A

vaginal delivery recommended

48
Q

If the presenting twin is cephalic, what would the advice be re. mode of delivery?

A

vaginal delivery recommended

49
Q

If the presenting twin is breech/transverse lie, what would the advice be re. mode of delivery?

A

CS

50
Q

How regular are the growth scans for DCDA?

A

4 weekly (from 24 weeks)

51
Q

How regular are MC twins scanned?

A

2 weekly (from 16 weeks)

GOSH (33 decks)

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