abnormal labour

Question 1

risk factors for preterm labour?

Answer 1

• lifestyle: smoking, alcohol, illicit drug use
• other: prior preterm labour, twin pregnancy, short cervical length, cervical surgery such as a cone biopsy
• conditions: urinary/ genital infections, and conditions associated with hypertension during pregnancy and placenta previa, or placenta abruption

Question 2

what is prophylaxis for preterm birth for those with a previous preterm birth or those with a short cervix?

Answer 2

Vaginal progesterone

Question 3

what is the threshold for delivery vs expectant management in preterm labour

Answer 3

• over 34 weeks can be delivered, under 34 weeks try to manage
• under 34 weeks- management will depend on cervical length- cleric longer than 30 m then the risk of delivering the baby in the next 7 days is low- observed and then followed up in 2 weeks
• if cervix is shorter than 20mm then the risk of delivery in the next 7 days is high and so medications need to be given

Question 4

what is given to patients if the cervix is <20mm at <34 weeks?

Answer 4

• antenatal corticosteroids to mature the fetal lungs
• tocolytic medications such as nifedipine (calcium channel blocker, NSAIDS, Trebetuline)—> these minimise uterine contractions and are given for up to 48hrs

they only delay labour long enough for corticosteroids to achieve maximal fetal effect

antibiotics are given to prevent an intrauterine infection and prevent group B strep infection in baby (usually found in vaginal flora)

Question 5

what is preterm labour?

Answer 5

Preterm labor is when regular uterine contractions and cervical changes, which include cervical effacement, or thinning and dilation, start before 37 weeks gestation, but later than 20 or 24 weeks.

Question 6

when is magnesium sulphate given and why?

Answer 6

magnesium sulfate is given for pregnancies less than 32 weeks, which protects the fetal nervous system, and decreases the risk of developing cerebral palsy.

Question 7

what do you check if the cervical length I between 20- 30mm?

Answer 7

if cervical length is between 20 and 30 millimeters, a cervicovaginal discharge sample is tested for fetal fibronectin, which is a protein made by the fetal membranes.

If fetal fibronectin is positive, the risk of delivery in the next 7 days is high, and corticosteroids, tocolytics, antibiotics and magnesium sulfate are given to decrease the risk of fetal complications.

Question 8

which instance3s warrant continuous CTG?

Answer 8

• suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
• severe hypertension 160/110 mmHg or above
• oxytocin use
• the presence of significant meconium
• fresh vaginal bleeding that develops in labour

Question 9

what needs to be in place for instrumental delivery? (FORCEPS)

Answer 9

• fully dilated cervix generally the second stage of labour must have been reached
• OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
• Ruptured Membranes
• Cephalic presentation
• Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
• Pain relief
• Sphincter (bladder) empty this will usually require catheterization

Question 10

in what order are the layers of the abdomen cut in a c section?

Answer 10

Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

Question 11

what is the most risky form of breech?

Answer 11

Footling presentations are a rare but the most risky form of breech- there is a 5-20% risk of cord prolapse, which can obstruct foetal blood flow and is an obstetric emergency.

Question 12

what should be done immediately after shoulder dystocia is recognised?

Answer 12

additional help should be called

Question 13

what a a kleihauler test?

Answer 13

a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.[1] It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive children.

Question 14

what us an absolute contraindication to vaginal delivery post c-section?

Answer 14

vertical c-section scar

Question 15

what are signs and symptoms of amniotic fluid embolisation?

Answer 15

The majority of cases occur in labour , though they can also occur during caesarean section and after delivery in the immediate postpartum.

Symptoms include: chills, shivering, sweating, anxiety and coughing.

Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.

Question 16

what is the name of the palsy caused by brachial plexus damage due to shoulder dystocia?

Answer 16

erbs palsy
- abduccted and internally rotated arm

recover 4 weeks after birth, and will go away in first year of life