Abnormal labour and delivery Flashcards
What is the most important risk factor for breech presentation?
Prematurity
What are the three main types of breech presentation?
Frank, complete, footling
What are the complications associated with breech presentations at labour?
Developmental dysplasia of the hip
Birth trauma
Caesarean section
Instrumental delivery
At what time during pregnancy should external cephalic version be attempted?
At 37 weeks
What medications should be given with ECV?
Anti-D (and Kleihaur)
Tocolytics (optional) to relax the uterus
What is Lovset’s manoeuvre?
Manouvre in breech delivery that prevents nuchal arms (behind the neck)
- Hold the hips and turn a half circle while applying downward traction
- Sweep the anterior arm down over the chest
- Turn a half circle
- Do the name with the other arm
What is the Mauriceau-Smellie-Veit manoeuvre?
Method for head deliver in breech presentations
What is the definition of unstable lie?
This is when, after 37 weeks, the fetal lie is found to be in a different orientation at each palpation.
What are the normal rates of progression in terms of cervical dilation?
Primip - 0.5 - 1 cm/h Multip - 1 - 2 cm/h
How do we manage a fetus presenting in the occipito-posterior position?
Most will rotate spontaneously Those that don’t will either still deliver without problems, or can be turned manually or with an instrument.
Why is it important to monitor fetus after administration of IV syntocinon?
If contractions become too frequent this can reduce oxygen exchange in the placental bed and lead to fetal hypoxia
What is McRoberts position?
Hyperflex the mother’s knees onto her abdomen with her hips apart and apply suprapubic pressure
How does artificial rupture of membrane help labour along?
Thought to release prostaglandins.
What is Erb’s palsy?
Damage to nerve roots C4, C5 and C6 leading to paralysis of the arm
What are the complications of ventouse assisted delivery?
Foetal
- ICH, subgaleal haemorrhage
- Scalps abrasions and lacerations
- Retinal haemorrhage
- Shoulder dystocia → brachial plexus injury
Maternal
- Genital trauma
What are the factors associated with the fetus (passenger) that might lead to labour failing to progress?
Fetal size - macrosomia
Fetal malpresentation
Fetal malposition
What are the maternal indications for using forceps to assist delivery?
Maternal effort contraindicated e.g. cardiac disease, hypertension, proliferative retinopathy
What are the fetal indications for using forceps to assist delivery?
Suspected or anticipated foetal compromise
- Foetal descent which may precipitate cord compression
- When foetus cannot tolerate intense uterine activity and expulsive efforts by the mother
What are the risks of term PROM?
Cord prolapse
Cord compression
Placental abruption
Maternal and neonatal infection
How should term PROM be investigated if diagnosis is uncertain?
Sterile speculum with nitralazine/Amnisure
AVOID DIGITAL VAGINAL EXAMINATION (risk of infection)
When is fetal fibronectin measured?
Distinguishing true preterm labour from false labour
ECM protein present at the decidual-chorionic interface. Detected when this interface is disrupted
What antibiotic is used intrapartum for GBS +ve women who are allergic to penicillin?
Base on sensitivies
Clindamycin, cefazolin and vancomycin are commonly used
How are 3rd degree perineal tears further subdivided?
3A < 50% external anal sphincter
3B > 50% external anal sphincter
3C external and internal anal sphincter
What are the benefits of forceps over vacuum extraction?
Higher success rates
Lower foetal morbidity
What are the benefits of vacuum extraction over forceps delivery?
Easy
Less anaesthesia required
Less maternal soft tissue injury
