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403- O&G > Cord prolapse, abnormal fetal positioning, pre-term labour > Flashcards

Cord prolapse, abnormal fetal positioning, pre-term labour Flashcards

1
Q

Pre-term labour is when…

A

Contraction occurs during pregnancy which can progress to cervical effacement + dilation <37 weeks.

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2
Q

Risk factors for pre-term labour

A

Maternal factors

  • Genital tract infection
  • Autoimmune condition
  • Diabetes

Uterine/cervical factors

  • Congenital uterine abnormalities
  • Cervical incompetence

Others

  • Antepartum haemorrhage
  • Multiple pregnancy
  • PROM
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3
Q

What investigations are carried out for pre-term labour in intact membranes >30 weeks

A

Transvaginal USS for cervical length

2nd line= Foetal fibronectin

Vaginal swab for infections

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4
Q

A foetal fibronectin level ______ indicates a _______ chance of labour

A

<50ng/mL = unlikely in labour

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5
Q

What two markers are investigated for in premature rupture of membranes

A

Placental Alpha-microglobulin- 1 (PAMG-1)

Insulin-like growth factor binding protein 1 (IGFBP-1)

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6
Q

Tocolysis is indicated in pre-term labour that is…

A

Between 26 - 33+6 weeks in NON-ruptured membranes

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7
Q

First line management of pre-term labout in 26- 33+6, non ruptured membranes

A

Tocolysis

- Nifedipine

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8
Q

What is the second line agent for preterm labour in intact membranes, weeks 25-33+6

A

Atosiban

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9
Q

Management of ruptured membranes in pre-term labour 26-33+6 weeks

A

Corticosteroids

- Fetal lung development

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10
Q

_______ should be given at weeks ________ in pre-term labour to reduce the risk of cerebral palsy

A

Magnesium sulfate IV,

weeks 24-34

  • Offer in <30 weeks
  • Consider in >30 weeks
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11
Q

In pre-term labour, c-section is indicated if the baby is _______ with a gestational age _____

A

Breech, <32 weeks

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12
Q

What medication is given in PROM

A

Erythromycin 250mcg 10 days/ until labour

Antenatal steroids from 24 weeks

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13
Q

At what gestational age is delivery considered for PROM

A

34 weeks

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14
Q

Extreme preterm is defined as gestation age…

A

<28 weeks

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15
Q

Medical prophylaxis for preterm labour

A 
Vaginal progesterone (gel/ pessary)
- Decreases contraction activity
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16
Q

Vaginal progesterone is offered as prophylaxis for preterm labour when…

A

Cervical length <25 mm in USS 16-24 weeks

17
Q

Surgical prophylaxis for preterm labour

A

Cervical cerclage

18
Q

Cervical clerage is offered for preterm labour when…

A

Cervical length< 25nn on USS 16-24 weeks

Previous preterm labour

Cervical trauma (i.e. cone biopsy)

19
Q

Cervical clerage is offered for preterm labour when…

A

Cervical length< 25nn on USS 16-24 weeks

Previous preterm labour

Cervical trauma (i.e. cone biopsy)

20
Q

Rescure clerage involves…

A

Stitching the cervix to offer support in cervical dilation without ROM

Weeks 16-27+6

21
Q

A cervical length of ______ at gestational age _______is unlikely for preterm labour

A

> 15mm, >30 weeks gestation

22
Q

Mechanism of atosiban

A

Oxytocin receptor antagonist

- Stops uterine contractions

23
Q

Risk factors for umbilical cord prolapse

A

Most significant= Abnormal lie >37 weeks

Polyhydroaminos

Multiparity

Low lying placenta

Small baby

Long umbilical cord

Artificial amniotomy

24
Q

Complications of cord prolapse

A

Foetal hypoxia –> brain damage –> death

25
Q

Examination for cord prolapse

A

CTG
- Shows fetal distress

Speculum/ internal vaginal exam
- Cord prolapse visible

26
Q

Acute management of cord prolapse

A
  1. Call obstetric and neonatal emergency
  2. Mother on left lateral, on all fours. Remove fetal head from cord.
  3. Discontinue oxytocin
  4. CTG monitoring.
  5. Cannulation for bloods: FBC, group + save
27
Q

Emergency C-section is indicated in cord prolapse when

A

Abnormal foetal HR

Occult prolapse (cord alongside fetus)

28
Q

In an emergency c-section, delivery needs to occur within…

A

30 mins

29
Q

Breech is likely to spontaneously resolve by…

A

36 weeks

30
Q

_____% of vaginal births at breech end in an emergency C-section

A

40

31
Q

______ is indicated for breech at _____ weeks for nulliparous women and ______ weeks for multiparous women

A

External cephalic version

36 for primigravida

37 weeks for multiparous

32
Q

External cephalic version has a ____% success rate

A

50-60%

33
Q

______ should be given in _____ mothers during ECV

A

Anti-D immunoglobulins for Rh-D negative mothers

34
Q

The most common breech presentation is…

A

Frank breech (both legs fully flexed at hip and extended at knees)

35
Q

Risk factors for breech

A
  • Uterine malformations, fibroids
  • Placenta praevia
  • Polyhydramnios or oligohydramnios
  • Foetal abnormality (e.g. CNS malformation, chromosomal disorders)
  • Prematurity (due to increased incidence earlier in gestation)
36
Q

Complications of breech presentation

A

Umbilical cord prolapse

37
Q

Benefit of planned C-section for breech at term compared to vaginal delivery

A
  • Low risk of early neonatal morbidity and perinatal mortality for babies
38
Q

Contraindications for external cephalic version [6]

A

Where C-section is required

Post-partum haemorrhage within the last 7 days

Abnormal CTG

Major uterine anomaly

Ruptured membranes

Multiple pregnancy

403- O&G (21 decks)

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