complications of labour

Question 1

amniotic fluid embolism + risk factors

Answer 1

when fetal cells/amniotic fluid enters the mothers bloodstream

risk factors
- maternal age
- induction of labour

Question 3

presentation of amniotic fluid embolism

Answer 3

most occur in labour
- can occur during C-section + immediate postpartum

chills, sweating/shivering, anxiety, coughing
O/E - cyanosiss, hypotention, bronchospasms, tachycardia, MI

diagnosis = of exclusion

Question 4

risk factors for breech presentation

Answer 4

• uterine malfomation - fibroids
• placenta praevia
• poly- or oligohydramnios
• fetal abnormality - CNS malformation, chromosomal disorders

prematurity (increased incidence earlier in gestation)

cord prolapse more common in breech presentations

Question 5

management of breech

Answer 5

<36wks - wait
>36wks - external cephalic version (ECV)
- 60% success rate
- offer 36wk nullipar, 37wk multi

Question 6

contraindications of external cephalic version (ECV)

Answer 6

• c-section is required
• antepartum haemorrhage within 7 days
• abnormal CTG
• major uterine anomaly
• ruptured membranes
• multiple pregnancy

Question 7

indications for c-section

Answer 7

absolute cephalopelvic disproportion
placenta praevia grades 3/4
pre-eclampsia
post-maturity
IUGR
fetal distress in labour/prolapsed cord
failure of labour to progress
malpresentations: brow
placental abruption: only if fetal distress; if dead deliver vaginally
vaginal infection e.g. active herpes
cervical cancer (disseminates cancer cells)

Question 8

c-section categories

Answer 8

cat 1 - immediate threat to life of mum or baby
- abruption/rupture, cord prolapse, fetal bradycardia(persistent)
- deliver within 10 mins of decision

cat 2 - within 75mins, compromise which is not immediately life threatening

cat 3 - delivery require, mum/baby stable

cat 4 - elective c-section

Question 9

c-section risks to future pregnancies

Answer 9

increased risk of uterine rupture during subsequent pregnancies/deliveries

increased risk of antepartum stillbirth

increased risk in subsequent pregnancies of placenta praevia and placenta accreta

Question 10

vaginal birth after caesarean (VBAC)

Answer 10

planned VBAC is appropriate method of delivery for women at >= 37 weeks gestation with a single previous Caesarean delivery
- around 70-75% of women in this situation have a successful vaginal delivery

contraindications = previous uterine rupture or classical caesarean scar (logitudinal vs lower segment (99%))

Question 11

chorioamnionitis

Answer 11

usually result of ascending infection of te amniotic fluid / membranes / placenta
- med emerg, life threat

major RF = preterm prmature rupture of membranes

mx = deliver foetus (via section if necessary), IV antibiotics

Question 13

Indications for a forceps delivery

Answer 13

• fetal distress in the second stage of labour
• maternal distress in the second stage of labour
• failure to progress in the second stage of labour
• control of head in breech deliver

Question 14

contraindications to ventouse delivery

Answer 14

• <34 weeks
• cephalopelvic disproportion
• breach, face or brow presentation

Question 15

complications of ventouse delivery

Answer 15

cephalhaematoma
retinal haemorrhages
maternal infection
- single dose IV co-amoxiclav prophylaxis should be given

Question 16

complications of transverse lie

Answer 16

preterm rupture of membranes (PROM)
cord-prolapse (20%)

mx = same as breech

Question 17

shoulder dystocia risk factors

Answer 17

• fetal macrosomia (DM)
• high maternal BMI
• diabetes
• prolonged labour

Question 18

management of shoulder dystocia

Answer 18

senior help + McRoberts manoeuvre
- flexion + abduction of maternal hips, bring thighs towards abdomen
– increase relative AP angle of pelvis

(episiotimy will not reliece bony obstruction but sometimes used to allow acces for internal manoevres)

Question 19

complications of shoulder dystocia

Answer 19

maternal
- PPH
- perineal tears

fetal
- brachial plexus injury
- neonatal death

Question 20

risk factors for perineal tears

Answer 20

primigravida
large babies
precipitant labour
shoulder dystocia
forceps delivery

Question 21

what is puerperal pyrexia

Answer 21

temp of >38 in first 14days following delivery

Question 22

causes of puerperal pyrexia

Answer 22

• endometritis: most common cause
• urinary tract infection
• wound infections (perineal tears + caesarean section)
• mastitis
• venous thromboembolism

Question 23

endometritis mx

Answer 23

IV clidamycin + gentamicin
until afebrile for>24hrs

Question 24

classification and Mx of perineal tears

Answer 24

1st degree - superficial damage one, no repair required

2nd - injury to muscle but not involving sphicter, requires sutures

3rd - injury involving anal sphincter complex - internal + external
requires repair in theatre

4th - injury to sphinter complex and retal mucosa, requires repair in theatre