Cord prolapse, abnormal fetal positioning, pre-term labour Flashcards
Pre-term labour is when…
Contraction occurs during pregnancy which can progress to cervical effacement + dilation <37 weeks.
Risk factors for pre-term labour
Maternal factors
- Genital tract infection
- Autoimmune condition
- Diabetes
Uterine/cervical factors
- Congenital uterine abnormalities
- Cervical incompetence
Others
- Antepartum haemorrhage
- Multiple pregnancy
- PROM
What investigations are carried out for pre-term labour in intact membranes >30 weeks
Transvaginal USS for cervical length
2nd line= Foetal fibronectin
Vaginal swab for infections
A foetal fibronectin level ______ indicates a _______ chance of labour
<50ng/mL = unlikely in labour
What two markers are investigated for in premature rupture of membranes
Placental Alpha-microglobulin- 1 (PAMG-1)
Insulin-like growth factor binding protein 1 (IGFBP-1)
Tocolysis is indicated in pre-term labour that is…
Between 26 - 33+6 weeks in NON-ruptured membranes
First line management of pre-term labout in 26- 33+6, non ruptured membranes
Tocolysis
- Nifedipine
What is the second line agent for preterm labour in intact membranes, weeks 25-33+6
Atosiban
Management of ruptured membranes in pre-term labour 26-33+6 weeks
Corticosteroids
- Fetal lung development
_______ should be given at weeks ________ in pre-term labour to reduce the risk of cerebral palsy
Magnesium sulfate IV,
weeks 24-34
- Offer in <30 weeks
- Consider in >30 weeks
In pre-term labour, c-section is indicated if the baby is _______ with a gestational age _____
Breech, <32 weeks
What medication is given in PROM
Erythromycin 250mcg 10 days/ until labour
Antenatal steroids from 24 weeks
At what gestational age is delivery considered for PROM
34 weeks
Extreme preterm is defined as gestation age…
<28 weeks
Medical prophylaxis for preterm labour
Vaginal progesterone (gel/ pessary) - Decreases contraction activity
Vaginal progesterone is offered as prophylaxis for preterm labour when…
Cervical length <25 mm in USS 16-24 weeks
Surgical prophylaxis for preterm labour
Cervical cerclage
Cervical clerage is offered for preterm labour when…
Cervical length< 25nn on USS 16-24 weeks
Previous preterm labour
Cervical trauma (i.e. cone biopsy)
Cervical clerage is offered for preterm labour when…
Cervical length< 25nn on USS 16-24 weeks
Previous preterm labour
Cervical trauma (i.e. cone biopsy)
Rescure clerage involves…
Stitching the cervix to offer support in cervical dilation without ROM
Weeks 16-27+6
A cervical length of ______ at gestational age _______is unlikely for preterm labour
> 15mm, >30 weeks gestation
Mechanism of atosiban
Oxytocin receptor antagonist
- Stops uterine contractions
Risk factors for umbilical cord prolapse
Most significant= Abnormal lie >37 weeks
Polyhydroaminos
Multiparity
Low lying placenta
Small baby
Long umbilical cord
Artificial amniotomy
Complications of cord prolapse
Foetal hypoxia –> brain damage –> death
Examination for cord prolapse
CTG
- Shows fetal distress
Speculum/ internal vaginal exam
- Cord prolapse visible
Acute management of cord prolapse
- Call obstetric and neonatal emergency
- Mother on left lateral, on all fours. Remove fetal head from cord.
- Discontinue oxytocin
- CTG monitoring.
- Cannulation for bloods: FBC, group + save
Emergency C-section is indicated in cord prolapse when
Abnormal foetal HR
Occult prolapse (cord alongside fetus)
In an emergency c-section, delivery needs to occur within…
30 mins
Breech is likely to spontaneously resolve by…
36 weeks
_____% of vaginal births at breech end in an emergency C-section
40
______ is indicated for breech at _____ weeks for nulliparous women and ______ weeks for multiparous women
External cephalic version
36 for primigravida
37 weeks for multiparous
External cephalic version has a ____% success rate
50-60%
______ should be given in _____ mothers during ECV
Anti-D immunoglobulins for Rh-D negative mothers
The most common breech presentation is…
Frank breech (both legs fully flexed at hip and extended at knees)
Risk factors for breech
- Uterine malformations, fibroids
- Placenta praevia
- Polyhydramnios or oligohydramnios
- Foetal abnormality (e.g. CNS malformation, chromosomal disorders)
- Prematurity (due to increased incidence earlier in gestation)
Complications of breech presentation
Umbilical cord prolapse
Benefit of planned C-section for breech at term compared to vaginal delivery
- Low risk of early neonatal morbidity and perinatal mortality for babies
Contraindications for external cephalic version [6]
Where C-section is required
Post-partum haemorrhage within the last 7 days
Abnormal CTG
Major uterine anomaly
Ruptured membranes
Multiple pregnancy
