Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 4 - GOSH > Antenatal Care: Breech Presentation, Stillbirth & Cardiac Arrest > Flashcards

Antenatal Care: Breech Presentation, Stillbirth & Cardiac Arrest Flashcards

1
Q

What does the breech presentation refer to?

A

Breech presentation refers to when the presenting part of the fetus (the lowest part) is the legs and bottom.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the cephalic presentation refer to?

A

Where the head is presenting first.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Frequency of breech presentation?

A

occurs in <5% pregnancies by 37 weeks gestation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 types of breech?

A

1) Complete

2) Incomplete

3) Extended

4) Footling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a complete breech?

A

Where the legs are fully flexed at the hips and knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an incomplete breech?

A

With one leg flexed at the hip and extended at the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an extended breech?

A

Also known as frank breech.

Both legs flexed at hip and extended at knee.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a footling breech?

A

A foot is presenting through the cercix with the leg extended.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of babies that are breech before 36 weeks?

A

These often turn spontaneously - no intervention is advised.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management options of babies that are breech at term (37 weeks)?

A

1) External cephalic version (ECV): can be used at term (37 weeks) to attempt to turn the fetus.

If ECV fails:

2) Choice of vaginal delivery or elective caesarian section.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vaginal birth vs caesarian section in breech babies?

A

Overall, vaginal birth is safer for the mother, and caesarean section is safer for the baby.

There is about a 40% chance of requiring an emergency caesarean section when vaginal birth is attempted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What delivery is required when the first baby in a twin pregnancy is breech?

A

Caesarian section is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is external cephalic version (ECV)?

A

A technique used to attempt to turn a fetus from the breech position to a cephalic position using pressure on the pregnant abdomen.

It is about 50% successful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Success rate of ECV?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is ECV used in babies that are breech (i.e. how many weeks)?

a) for nulliparous women

b) for women that have previously given birth

A

a) After 36 weeks for nulliparous women

b) After 37 weeks in women that have given birth previously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are women given prior to ECV?

A

Tocolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Purpose of tocolysis prior to ECV?

A

To relax the uterus before the procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is tocolysis? What medication is used?

A

Tocolysis is with subcutaneous terbutaline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is terbutaline?

A

Beta agonist (similar to salbumatol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

mechanism of terbutaline in ECV?

A

Reduces the contractility of the myometrium, making it easier for the baby to turn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do rhesus-D negative women require before ECV?

A

Anti-D prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What test is used to determine the dose of anti-D required prior to ECV in rhesus-D negative women?

A

A Kleihauer test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What % of babies are breech:
a) at 28 weeks
b) near term

A

a) 25%
b) 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What type of breech position is most common?

A

Frank breech (hips flexed and knees fully extended)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Risk factors for breech presentation?
1) uterine malformations, fibroids 2) placenta praevia 3) polyhydramnios or oligohydramnios 4) fetal abnormality (e.g. CNS malformation, chromosomal disorders) 5) prematurity (due to increased incidence earlier in gestation
26
What is cord prolapse?
An umbilical cord prolapse happens when the umbilical cord slips down in front of the baby after the waters have broken.
27
What complication is more common in breech presentation?
Cord prolapse
28
What are some absolute contraindications to ECV?
1) where caesarean delivery is required 2) antepartum haemorrhage within the last 7 days 3) abnormal cardiotocography 4) major uterine anomaly 5) ruptured membranes 6) multiple pregnancy
29
What is umbilical cord prolapse?
Umbilical cord prolapse involves the umbilical cord descending ahead of the presenting part of the fetus. This occurs in 1/500 deliveries.
30
Risk of untreated cord prolapse?
Can lead to compression of the cord or cord spasm --> can cause fetal hypoxia --> eventually irreversible damage or death.
31
Risk factors for cord prolapse?
- prematurity - multiparity - polyhydramnios - twin pregnancy - cephalopelvic disproportion - abnormal presentations e.g. Breech, transverse lie
32
When do 50% of cord prolapses occur?
at artificial rupture of the membranes.
33
How is diagnosis of cord prolapse made?
Usually made when: a) the fetal heart rate becomes abnormal b) the cord is palpable vaginally, or if the cord is visible beyond the level of the introitus.
34
Management of cord prolapse?
Obstetric emergency. 1) the presenting part of the fetus may be pushed back into the uterus to avoid compression 2) if the cord is past the level of the introitus, there should be minimal handling and it should be kept warm and moist to avoid vasospasm 3) the patient is asked to go on 'all fours' until preparations for an immediate caesarian section have been carried out 4) tocolytics may be used to reduce uterine contractions 5) retrofilling the bladder with 500-700ml of saline may be helpful as it gently elevates the presenting part
35
1st line method of delivery in cord prolapse?
Caesarian section
36
What class of drug reduces uterine contractions?
tocolytis
37
Define stillbirth
The birth of a dead fetus after 24 weeks gestation. Stillbirth is the result of intrauterine fetal death (IUFD).
38
Stillbirth vs miscarriage?
Miscarriage - before 24 weeks Stillbirth - after 24 weeks
39
Causes of stillbirth?
- Unexplained (around 50%) - Pre-eclampsia - Placental abruption - Vasa praevi - Cord prolapse or wrapped around fetal neck - Obstetric cholestasis - Diabetes - Thyroid disease - Infections e.g. rubella, parvovirus, listeria - Genetic abnormalities or congenital malformations
40
What are some factors that increase the risk of stillbirth?
1) Foetal growth restriction 2) Smoking 3) Alcohol 4) Increased maternal age 5) Maternal obesity 6) Twins 7) Sleeping on the back (as opposed to either side)
41
How can risk of stillbirth be assessed & mitigated?
1) A risk assessment for having a baby that is small for gestational age (SGA) or with fetal growth restriction (FGR) is performed on all pregnant women. Having risk factors for SGA increases the risk of stillbirth. Those at risk have the fetal growth closely monitored with serial growth scans. 2) Risk of pre-eclampsia - aspirin 3) Treat modifiable risks e.g. stop smoking, effective control of diabetes, avoid alcohol, advise sleeping on side (not back)
42
What are the 3 key symptoms to always ask about during pregnancy?
1) Reduced fetal movements 2) Abdominal pain 3) Vaginal bleeding
43
What is the investigation of choice for diagnosing intrauterine fetal death (IUFD)?
US scan: to visualise fetal heartbeat to confirm the fetus is still alive.
44
Why is a repeat US scan offered in intrauterine foetal death?
Passive fetal movements are possible after IUFD, and a repeat scan is offered to confirm the situation.
45
What must rhesus-D negative women be offered when intrauterine fetal death (IUFD) iis diagnosed?
anti-D prophylaxis
46
1st line delivery for most women after IUFD?
Vaginal birth. Women given choice of: 1) induction of labour 2) expectant management (provided immediate delivery is not required e.g. sepsis, pre-eclampsia, haemorrhage)
47
What is expectant management of stillbirth?
awaiting natural labour and delivery: need close monitoring as the condition of the fetus will deteriorate with time.
48
What is used in the induction of labour in stillbirth?
Combination of: 1) oral mifepristone (anti-progesterone) 2) vaginal or oral misoprostol (prostaglandin analogue)
49
What can be used to suppress lactation after stillbirth?
Dopamine agonists (e.g. cabergoline)
50
What class of drug is mifepristone?
anti-progesterone
51
What class of drug is misoprostol?
Prostaglandin analogue
52
What class of drug is cabergoline?
Dopamine agonists
53
What testing can be carried out after stillbirth (with parental consent)?
To determine the cause: 1) Genetic testing of the fetus and placenta 2) Postmortem examination of the fetus (including xrays) 3) Testing for maternal and fetal infection 4) Testing the mother for conditions associated with stillbirth, such as diabetes, thyroid disease and thrombophilia
54
Purpose of testing post-stillbirth?
Identifying the cause can help reduce the risk in future pregnancies.
55
Support after stillbirth?
Counselling is offered to women, partners and family members. They are supported with their individual wishes, such as seeing the baby, naming the baby and keeping photographs (although not persuaded either way with what to do). They are also supported with wishes for funeral arrangements and services.
56
What are the reversible causes of adult cardiac arrest (4 Ts and 4 Hs)?
4 Ts: 1) Thrombosis (PE or MI) 2) Tension pneumothorax 3) Toxins 4) Tamponade (cardiac) 4 Hs: 1) Hypoxia 2) Hypovolaemia 3) Hypothermia 4) Hyperkalaemia, hypoglycaemia, and other metabolic abnormalities Others: - Eclampsia - Intracranial haemorrhage
57
What are the 3 major causes of cardiac arrest in pregnancy?
1) Obstetric haemorrhage: major cause of severe hypovolaemia and cardiac arrest. 2) PE 3) Sepsis leading to metabolic acidosis and septic shock
58
What are 5 major causes of massive obstetric haemorrhage?
1) Ectopic pregnancy (earlier pregnancy) 2) Placental abruption (including concealed haemorrhage) 3) Placenta praevia 4) Placenta accreta 5) Uterine rupture
59
How can a pregnant woman lying on her back lead to hypotension (sometimes enough to lead to the loss of cardiac output and cardiac arrest)?
Aortocaval compression: 1) When a pregnant woman lies on her back (supine), the mass of the uterus can compress the inferior vena cava and aorta. 2) The compression on the vena cava is most significant, as it reduces the blood returning to the heart (venous return) 3) This reduces the cardiac output, leading to hypotension. 4) In some instances, this can be enough to lead to the loss of cardiac output and cardiac arrest.
60
Solution to aortocaval compression?
The vena cava is slightly to the right side of the body --> place the woman in the left lateral position, lying on her left side, with the pregnant uterus positioned away from the inferior vena cava. This should relieve the compression on the inferior vena cava and improve venous return and cardiac output.
61
What factors make resuscitation more complicated in pregnancy?
1) Aortocaval compression 2) Increased oxygen requirements 3) Splinting of the diaphragm by the pregnant abdomen 4) Difficulty with intubation 5) Increased risk of aspiration 6) Ongoing obstetric haemorrhage
62
Principles in pregnancy for resuscitation?
1) A 15 degree tilt to the left side for CPR, to relieve compression of the inferior vena cava and aorta 2) Early intubation to protect the airway 3) Early supplementary oxygen 4) Aggressive fluid resuscitation (caution in pre-eclampsia) 5) Delivery of the baby after 4 minutes, and within 5 minutes of starting CPR
63
When is immediate caesarian section performed in pregnant women needing resuscitation?
1) There is no response after 4 minutes to CPR performed correctly 2) CPR continues for more than 4 minutes in a woman more than 20 weeks gestation
64
In cardiac arrest in pregnancy, how soon after starting CPR should baby and placenta be delivered?
The aim is to deliver the baby and placenta within 5 minutes of CPR commencing. CPR should be continued for more than 4 minutes. The operation is performed at the site of the arrest, for example, in A&E resus or on the ward.
65
What is the primary reason for immediate delivery in cardiac arrest in pregnancy?
Improve the survival of the mother
66
Where is delivery performed in cardiac arrest in pregnancy?
at the site of the arrest, for example, in A&E resus or on the ward.
67
How can delivery improve maternal outcomes in cardiac arrest in preganancy?
Delivery improves the venous return to the heart, improves cardiac output and reduces oxygen consumption. It also helps with ventilation and chest compressions. Delivery increases the chances of the baby surviving, although this is secondary to the survival of the mother.
68

Yr 4 - GOSH (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions