Abnormal labour and antenatal screening Flashcards
What is preterm labour?
Onset of labour before 37/40.
What is the aetiology of preterm labour?
Idiopathic, infection (subclinical).
Asociations / Risk factors
Infection of GU, UTI, multiple, PHMN, cervical incompetence or previous surgery, systemic infection, previous PTL, uterine anomalies, APH.
What is the epidemiology of preterm labour?
6%
What is the history/ exam of preterm labour?
Regular painful contractions, or diffuse pain or cramping. May have PV bleed/PPROM.
General: infeciton signs.
Abdomen: contractions, tenderness (abruption/chorioamnionitis)
Speculum: liquid pooling.
Vaginal: assess dilaiton.
What is the pathology of preterm labour?
Relationship with infective illness due to direct spread of infection or release of inflammatory mediators. Decidual haemorrage is associated with inflammatory mediators. PTL in PHMN/multople associated to overdistension.
What investigations do you do for preterm labour?
Blood: FBc, UE, CRP, LFT, X match.
Micro: MUS, LVS/HVS.
CTG for fetal wellbeing, USS to confirm presentation, estimate wt, cervical length.
Fetal fibronection: sample taken at speculum exam, predictiveo of labour likelihood. HIGH NEGATIVE PREDICTIVE VALUE (i.e. if -, unikely labour)
What is the management of preterm labour?
Administer steroid for lung maturity, tocolysis used to allow steroid cover (see earlier). If SROM, fetal monitoring
What are the complications/ prognosis of preterm labour?
RDS, ICH, sepsis, NEC, NDD,elay, cerebral palsy, neonate death 20% of perinatal mortality due to PTL. 20% risk in subsequent pregnancies.
What is prolonged labour?
Poor progress in labour
What is the aetiology of prolonger labour?
· First stage
o Primip: cervical dilation <2cm in 4h.
o Multip: cervical dilation <2cm in 4h and slowing.
o May be due to low contratcion frequency/duration, high size of baby or malpresentation, or CPD.
· Second stage
o Delay in delivery of >2h primip or >1h multip of active pushing.
· Third stage
o Failure to deliver placenta after 30 min with active management, >1h if physiological alone
o May be due to failure to detach placenta.
· First/second: primigravidity, maternal age, bid baby, short stature, obesity, induction of labour, epidural (reduces pushing), cervical surgery, pelvic trauma, fetal malformations.
· Third: previous retained placenta, previous uterine injury, preterm, induction, multiparity.
What is the epidemiology of prolonged labour?
First/second 30-50% of C section cause. Third stage in 1% births.
What is the history/ exam of prolonged labour?
First/second stage:
· General: exhaustion, dehydration, blood stained urine.
· Abdomen: fetal size, lie, presentation, engagement.
· Vaginal: assess dilaiton, station, presentation, position, presence of membranes, sign of obstruction, assess pelvic capacity.
What is the pathology of prolonged labour?
Blood: FBC, GS, UE, X match.
CTG for fetal wellbeing.
What investigations do you do for prolonged labour?
Blood: FBC, GS, UE, X match.
CTG for fetal wellbeing.
What is the management of prolonged labour?
· First stage
o Rehydrate, pain relief, ARM, augment labour with oxytocin infusion, C section if malpresented. Consider FBS/delivery if distress fetus.
· Second stage
o Oxytocin. If fully dilated, <1/5 palpable abdominally and vertex at/below spines, instrumental delivery, otherwise C section
· Third stage
o Oxytocin, if stil retained after 30 min manual removal in theatre
What are the complications/ prognosis of prolonged labour?
First/second stage: Maternal: risks of instrumental delivery, PPH, uterine rupture, fistula,. Fetal distress, complications of instrumental delivery, risk of shoulder dystocia. Most cases respond to intervention but may need C seciton
Third stage: PPH, infection. Good prognosis.
What is a prolonged pregnancy?
Pregnancy > 42wk.
What is the RFs of prolonged pregnancy?
Previous post term, primiparity, obese.
What is the epidemiology of prolonged pregnancy?
5-15%.
What is the Hx/Ex of prolonged pregnancy?
Fail to enter spontaneous labour by 42wk. Ensure adequate fetal movements and accurate dating from early USS.
Abdomen: fundal height, ascultate FH.
Vaginal: assess cervix for induction of labour.
What is the pathology of prolonged pregnancy?
Placental funciton decreses post term (calcificaiton and syncytial knotting). Associated with increased rates of perinatal morbidity and mortality.
What is the Ix in prolonged pregnancy?
USS for liquor volume, growth
CTG for fetal wellbeing, at least twice weekly.
What is the management of prolonged pregnancy?
All women offered membrane sweeping from 40/40, to induce spontaneous labour. Inductiono flabour form end of 41 weeks. If denied, advised that no monitoring techniques are available to monitor fetal death.
What are the complications/ prognosis of prolonged pregnancy?
Increased risk of stillbirth, high risk of eprinatal morbidity and mortality, high risk of C section, meconium staining of liquor more common.
Recurs in 30% subsequent pregnancies.
