Congenital abnormalities and foetal wellbeing: Flashcards
List the 3 most common congenital abnormalities:
1) Neural tube defects
2) Congenital cardiac defects
3) Downs
List 3 types of neural tube defects:
- anencephaly
- Microcephaly
- Spina bifida (can survive but could lead to paraplegia and bowel+bladder incontinence, normal intelligence)
What can be given to prevent neural tube defects?
Folic acid - good effect
What two conditions are commonly associated with cardiac abnormalities?
- Oligohyramnios
- IUGR
List 5 congenital cardiac abnormalities:
- VSD
- ASD
- Pulmonary stenosis
- Aortic stenosis
- Coarctation of aorta
- Transposition of great vessels
- Tetralogy of Fallot
List 2 abdominal wall defects:
- Exomphalos
- Gastroschisis
(in both cases the bowel extrudes the abdominal wall)
List 3 chromosomal congenital abnormalities:
- Downs
- Edwards
- Pataus
Give 5 clinical risk factors for congenital abnormalities in late pregnancy:
1) Persistent breech presentation or abnormal lie
2) Vaginal bleeding
3) Abnormal foetal movements
4) abnormal amniotic fluid volume
5) IUGR
List 5 investigations you could perform if you suspect congenital abnormalities:
- US
- Doppler
- CVS
- Amniocentesis
- Nucheal translucency
- Amniotic fluid volume (US)
How many stages of labour are there?
3
What occurs during the first stage of labour?
The cervix relaxes causing it to dilate and thin out.
What occurs during the second stage of labour and when does it start/end?
Uterine contractions increase in strength and the infant is delivered.
From complete cervical dilation (10cm) until baby birth.
What should be done before encouraging the woman to bear down?
Vaginal examination to confirm cervical dilation and presenting part
What are the normal durations of second stage of labour?
2hrs - nulliparous
1hr - multiparous
(add 1 hr if had epidural)
Why is the supine position usually avoided during birth?
Due to risk of supine hypotensive syndrome
What does the APGAR score measure and what areas does it cover?
Wellbeing of the baby (1,5, 10 mins after delivery) A - Activity P - Pulse G - Grimace (reflex irritability) A - Appearance (skin colour) R - Respirations
What does the 3rd stage of labour involve?
- Administration of oxytocin (IM)
- Followed by late clamping (>2cm) and cutting of cord
- Pulling placenta
What is essential after an episiotomy?
Accurate repair - poor suturing could lead to dysparenunia or damage to the anal sphincter (incontinence of flatus and faeces)
What position do babies normally present in?
Vertex position (ideal is occipitoanterior - Left occipitoanteria (LOA) is best)
What is the management of those with face presentation?
Mentoanterior (forehead forward) - delivered normally unless it delays delivery
Instrumental or CS for rest
What is brow presentation?
When the head is flexed between face and vertex delivery.
Most unfavourable cephalic presentation.
What does a brow presentation require?
CS
What is deep transverse arrest?
When the head is lying anterior and posterior sections transversely across the pelvis and it does not move.
What type of delivery is indicated if one presents with deep transverse arrest?
CS or instrumental
What is common in occipitoposterior position of the baby head?
Severe (4th degree) tears due to large diameters.
NVD indicated (sometimes CS but head needs to be disengaged first)
List 5 indications of instrumental delivery:
- Delay in second stage of labour
- Non-reassuring foetal status (foetal distress
- Maternal exhaustion/medical disorders
- Resistance of pelvic floor
- Inadequate contractions
List 4 prerequisites for instrumental delivery:
- Full cervical dilation
- Thighs and perineum washed and draped
- Vertex presentation
- Head engaged and not palpable abdominally and station at or below spines
List 5 indications for CS:
- Foetal distress
- Abnormal progress in first and second stages of labour
IUGR due to poor placental function - Malpresentation: brow, transverse, breech
- Placenta praevia or other severe APH
- Previous CS
List the 4 categories of CS:
1) Immediate threat to baby or mothers life
2) Maternal or foetal compromise present but not immediately life-threatening
3) No maternal or foetal compromise but early delivery required
4) Elective CS
What are the complication of a CS?
Normal complications of pelvic surgery
List the management of shoulder dystocia:
1) summon help
2) Mother in recumbent position with hips fully flexed and slightly abducted (McRoberts manoeuvre)
3) Apply supra pubic pressure to anterior shoulder
4) Make or extend episiotomy
5) Insert had into vaginal and rotate the foetal shoulders to the oblique pelvic diameter
What are the two types of postpartum haemorrhage?
- Primary PPH (within 24hrs of delivery - 99% of PPH
- Secondary PPH (24hrs to 6 weeks after delivery)
List 5 RF of PPH:
- Uterine over-distention (e.g. multiple pregnancy, polyhydramnios)
- Prolonged labour, instrumental delivery
- APH
- Multiparity
- Multiple fibroids
- Genital tract trauma
- Episiotomy
(basically most trauma complications of pregnancy)
What management is needed in PPH if the placenta has not been removed?
- Massage uterus to ensure it is well contracted
- Attempt delivery of placenta through traction
- If it fails, manual removal under epidural or GA and resuscitate mother
What management is needed in PPH if the placenta has been removed?
1) Massage uterus to expel any retained clots
2) Inject IV oxytocin 5 units immediately and commence IV infusion of 40 units un 500ml of Hartmanns solution
3) If this fails administer ergometrine 0.2mg by IV injection
4) if fails adminsiter misoprostol rectally
5) IM 15-methyl-prostaglandin F2a and repeat every 15 mins
6) Blood samples to check for Hb%, coagulation disorders and cross matching
7) Check placenta and membranes whether they are complete
8) Vaginal and cervical exam
9) replace fluid loss
What does ergometrine and misoprostol do?
Causes uterine contractions
What are the risk factors for secondary PPH?
- Retained placental tissue
- Intrauterine infection
What are the symptoms of amniotic fluid embolism and what can it cause and why?
Sudden respiratory distress and cardiovascular collapse of mother.
Fatality.
Amniotic fluid enters mothers bloodstream and causes similar reaction to anaphylaxis and shock
