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Obs & Gynae (Obs) > Complications in Delivery > Flashcards

Complications in Delivery Flashcards

1
Q

A baby is born prematurely if it is delivered before what gestation?

A

37 weeks

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2
Q

What is the usual gestation and birthweight of viability of a foetus?

A

24 weeks, > 500g

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3
Q

What is the strongest risk factor for preterm delivery?

A

Previous preterm delivery

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4
Q

What is the main complication of PPROM for the mother?

A

Chorioamnionitis

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5
Q

Pooling of amniotic fluid in the posterior vaginal vault on speculum examination is suggestive of what diagnosis?

A

PPROM

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6
Q

Should you perform a digital vaginal examination in a woman with PPROM?

A

No

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7
Q

What may an ultrasound scan of a woman with PPROM show?

A

Oligohydramnios

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8
Q

How is PPROM managed medically?

A

10 day course of erythromycin and also give corticosteroids

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9
Q

At what gestation should delivery be considered in women with PPROM?

A

34 weeks

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10
Q

To assess the likelihood of preterm delivery in women who are deemed to be high risk, ultrasound is used to measure what?

A

Cervical length

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11
Q

Women with a cervical length of less than what are at higher risk of preterm birth?

A

25mm

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12
Q

What procedure can be used in women who have a high-risk of premature delivery to reduce the risk of this occurring?

A

Cervical suture (cerclage)

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13
Q

If an abdominal suture is inserted in a woman who is very high risk of premature delivery, how must the baby then be delivered?

A

C-section

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14
Q

If a woman presents with painful contractions and backache suggestive of premature labour, combined with PV bleeding, what is likely the event that triggered the labour?

A

Antepartum haemorrhage

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15
Q

If a woman presents with painful contractions and backache suggestive of premature labour, combined with loss of fluid vaginally, what is likely the event that triggered the labour?

A

PPROM

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16
Q

Premature labour can be diagnosed by examination alone once what is seen?

A

Cervical dilation > 3cm

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17
Q

The fibronectin or Actim Partus tests can be used to assess the likelihood of what complication?

A

Preterm delivery

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18
Q

In cases of suspected preterm labour, what investigations should be carried out to screen for infection?

A

Urine sample and vaginal swabs

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19
Q

After PPROM, what investigations are carried out to monitor for infection?

A

FBC and CRP

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20
Q

What is the aim of management of preterm labour?

A

To delay delivery to allow administration of corticosteroids and transfer to hospital

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21
Q

Via what route are corticosteroids given to women in preterm labour?

A

IM

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22
Q

The beneficial effects of maternal corticosteroids are apparent if the baby is born how long after the second dose? How long do the effects of the steroids last for?

A

24 hours / 7 days

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23
Q

What medications can be used in women in preterm labour to inhibit contractions and delay delivery?

A

Tocolytics

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24
Q

What is the commonest malpresentation at labour?

A

Breech presentation

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25
Q

For which malpresentations of the foetus is a vaginal delivery possible?

A

Breech and face presentations

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26
Q

For which malpresentations of the foetus is a vaginal delivery not possible?

A

Shoulder and brow presentations

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27
Q

If malpresentation of the foetus is suspected clinically, this can be confirmed with which investigation?

A

Ultrasound

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28
Q

What is the first line management option for malpresentation of the foetus?

A

External cephalic version

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29
Q

Is perinatal morbidity and mortality higher with a vaginal breech delivery or a C-section?

A

Vaginal breech delivery

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30
Q

A delay in the active phase of the first stage of labour would be suspected if there was less than how much change in cervical dilatation in a four hour period?

A

< 2cm

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31
Q

A delay in the active phase of the first stage of labour is confirmed if there is no change in cervical dilatation how long after artificial rupture of membranes?

A

2 hours

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32
Q

What position decreases the efficiency of uterine contractions during labour?

A

Supine

33
Q

Failure to progress in labour is always due to a problem with at least one of what three things?

A

Power, passage or passenger

34
Q

How are the frequency and strength of uterine contractions determined in labour in a woman with failure to progress?

A

Abdominal palpation

35
Q

How is the foetal size, presentation and position assessed in labour in a woman with failure to progress?

A

Abdominal palpation and vaginal examination

36
Q

If clinical examination is unhelpful, what investigation can be used to determine the foetal presentation?

A

Ultrasound

37
Q

What positions are best for increasing pelvic outlet dimensions in a woman with failure to progress?

A

Sitting/squatting

38
Q

What is the first line management option for women with suspected failure to progress in labour, with intact membranes?

A

Artificial rupture of membranes

39
Q

If failure to progress in labour is confirmed, what is the first line medical management?

A

IV syntocinon

40
Q

When giving IV syntocinon for failure to progress in labour, the dose should be up-titrated every 30 minutes until the frequency of contractions is what?

A

4-5 in 10 minutes

41
Q

What is the major concern with the use of syntocinon, particularly in the second stage of labour?

A

Risk of uterine hyperstimulation

42
Q

Vaginal examination is done 4 hours after starting oxytocin for failure to progress in labour. If cervical dilatation has not increased by 2cm, what is the management plan?

A

C-section delivery

43
Q

What is the management option for a delay in the second stage of labour where the foetal head is below station 0?

A

Operative vaginal delivery

44
Q

Antibiotic prophylaxis is given after manual removal of the placenta to prevent against what complication?

A

Endometritis

45
Q

What are the two main features of foetal distress?

A

Changes in the foetal heart rate on CTG and passage of meconium

46
Q

Would sign would make you consider there had been passage of meconium in utero?

A

Green/brown amniotic fluid

47
Q

What investigation is carried out next when a CTG is found to be pathological?

A

Foetal blood sampling

48
Q

What would be the appropriate management for foetal distress with a lactate of 4.1 or less, and a pH of 7.25 or more?

A

Repeat foetal blood sample in one hour if CTG abnormalities persist

49
Q

What would be the appropriate management for foetal distress with a lactate of 4.2-4.8 and a pH of 7.21-7.24?

A

Repeat foetal blood sample in 30 minutes if CTG abnormalities persist

50
Q

What would be the appropriate management for foetal distress with a lactate of 4.9 or more and a pH of 7.2 or less?

A

Urgent delivery

51
Q

What would be the correct management of a woman with meconium stained liquor before labour?

A

Immediate induction of labour

52
Q

Which type of operative vaginal delivery causes more perineal trauma?

A

Forceps

53
Q

Which type of operative vaginal delivery is most likely to be successful?

A

Forceps

54
Q

Which type of operative vaginal delivery is more likely to cause neonatal cephalohaematoma and retinal haemorrhage?

A

Ventouse

55
Q

What procedure is done alongside 90% of cases of operative vaginal delivery?

A

Episiotomy

56
Q

Which type of operative vaginal delivery is more likely to leave temporary marks on the baby’s head, and may rarely cause facial nerve palsies?

A

Forceps

57
Q

Which type of operative vaginal delivery is more likely to cause a chignon (a swelling on the babies head)? How soon does this usually resolve?

A

Ventouse - within 48 hours

58
Q

What is the most common reason for an elective C-section?

A

Previous C-section

59
Q

What are the 3 main indications for an emergency C section?

A

Foetal compromise, failure to progress despite syntocinon and cord prolapse

60
Q

Elective C-sections are usually done after what gestation?

A

39 weeks

61
Q

C-sections are associated with an increased risk of what respiratory complication in the newborn?

A

Transient tachypnoea of the newborn

62
Q

Within how long should an emergency (category 1) C-section be performed?

A

30 minutes

63
Q

What diagnosis should be suspected when there is a sudden decrease in foetal heart rate after rupture of membranes?

A

Cord prolapse

64
Q

What is the immediate management for a cord prolapse?

A

Elevate the foetal presenting part (to stop cord compression)

65
Q

What is the definitive management of cord prolapse?

A

Immediate delivery, usually via a C-section

66
Q

What diagnosis should be considered when the foetal body fails to deliver with axial traction after delivery of the foetal head?

A

Shoulder dystocia

67
Q

What are the major risk factors for shoulder dystocia?

A

Foetal macrosomia and maternal diabetes, and instrumental delivery

68
Q

Poor management of shoulder dystocia and pressure applied to the foetal neck can lead to what complication?

A

Foetal brachial plexus injury

69
Q

Why may an episiotomy be done in the management of shoulder dystocia?

A

To create more room for internal manoeuvres

70
Q

What is usually the first line manoeuvre for the management of shoulder dystocia?

A

McRoberts manoeuvre (hyper-flexed legs)

71
Q

What structures are involved in a 1st degree perineal tear?

A

Perineal skin only

72
Q

What structures are involved in a 2nd degree perineal tear?

A

Perineal skin and muscle

73
Q

A perineal tear involving < 50% of the external anal sphincter would be classified as what degree?

A

3A

74
Q

A perineal tear involving > 50% of the external anal sphincter would be classified as what degree?

A

3B

75
Q

A perineal tear involving the internal anal sphincter would be classified as what degree?

A

3C

76
Q

What structures are involved in a 4th degree perineal tear?

A

Internal and external anal sphincters, as well as anal epithelium

77
Q

When may an episiotomy be carried out?

A

Cases of foetal compromise and instrumental deliveries

78
Q

An episiotomy should be carried out at what point in labour?

A

Crowning

Obs & Gynae (Obs) (10 decks)

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