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O&G > Abnormal labour and delivery > Flashcards

Abnormal labour and delivery Flashcards

1
Q

What is the most important risk factor for breech presentation?

A

Prematurity

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2
Q

What are the three main types of breech presentation?

A

Frank, complete, footling

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3
Q

What are the complications associated with breech presentations at labour?

A

Developmental dysplasia of the hip

Birth trauma

Caesarean section

Instrumental delivery

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4
Q

At what time during pregnancy should external cephalic version be attempted?

A

At 37 weeks

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5
Q

What medications should be given with ECV?

A

Anti-D (and Kleihaur)

Tocolytics (optional) to relax the uterus

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6
Q

What is Lovset’s manoeuvre?

A

Manouvre in breech delivery that prevents nuchal arms (behind the neck)

  1. Hold the hips and turn a half circle while applying downward traction
  2. Sweep the anterior arm down over the chest
  3. Turn a half circle
  4. Do the name with the other arm
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7
Q

What is the Mauriceau-Smellie-Veit manoeuvre?

A

Method for head deliver in breech presentations

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8
Q

What is the definition of unstable lie?

A

This is when, after 37 weeks, the fetal lie is found to be in a different orientation at each palpation.

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9
Q

What are the normal rates of progression in terms of cervical dilation?

A

Primip - 0.5 - 1 cm/h Multip - 1 - 2 cm/h

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10
Q

How do we manage a fetus presenting in the occipito-posterior position?

A

Most will rotate spontaneously Those that don’t will either still deliver without problems, or can be turned manually or with an instrument.

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11
Q

Why is it important to monitor fetus after administration of IV syntocinon?

A

If contractions become too frequent this can reduce oxygen exchange in the placental bed and lead to fetal hypoxia

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12
Q

What is McRoberts position?

A

Hyperflex the mother’s knees onto her abdomen with her hips apart and apply suprapubic pressure

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13
Q

How does artificial rupture of membrane help labour along?

A

Thought to release prostaglandins.

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14
Q

What is Erb’s palsy?

A

Damage to nerve roots C4, C5 and C6 leading to paralysis of the arm

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15
Q

What are the complications of ventouse assisted delivery?

A

Foetal

  • ICH, subgaleal haemorrhage
  • Scalps abrasions and lacerations
  • Retinal haemorrhage
  • Shoulder dystocia → brachial plexus injury

Maternal

  • Genital trauma
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16
Q

What are the factors associated with the fetus (passenger) that might lead to labour failing to progress?

A

Fetal size - macrosomia

Fetal malpresentation

Fetal malposition

17
Q

What are the maternal indications for using forceps to assist delivery?

A

Maternal effort contraindicated e.g. cardiac disease, hypertension, proliferative retinopathy

18
Q

What are the fetal indications for using forceps to assist delivery?

A

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
19
Q

What are the risks of term PROM?

A

Cord prolapse

Cord compression

Placental abruption

Maternal and neonatal infection

20
Q

How should term PROM be investigated if diagnosis is uncertain?

A

Sterile speculum with nitralazine/Amnisure

AVOID DIGITAL VAGINAL EXAMINATION (risk of infection)

21
Q

When is fetal fibronectin measured?

A

Distinguishing true preterm labour from false labour

ECM protein present at the decidual-chorionic interface. Detected when this interface is disrupted

22
Q

What antibiotic is used intrapartum for GBS +ve women who are allergic to penicillin?

A

Base on sensitivies

Clindamycin, cefazolin and vancomycin are commonly used

23
Q

How are 3rd degree perineal tears further subdivided?

A

3A < 50% external anal sphincter

3B > 50% external anal sphincter

3C external and internal anal sphincter

24
Q

What are the benefits of forceps over vacuum extraction?

A

Higher success rates

Lower foetal morbidity

25
Q

What are the benefits of vacuum extraction over forceps delivery?

A

Easy

Less anaesthesia required

Less maternal soft tissue injury

O&G (13 decks)

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