Cord prolapse, abnormal fetal positioning, pre-term labour

Question 1

Pre-term labour is when…

Answer 1

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

Question 2

Risk factors for pre-term labour

Answer 2

Maternal factors

• Genital tract infection
• Autoimmune condition
• Diabetes

Uterine/cervical factors

• Congenital uterine abnormalities
• Cervical incompetence

Others

• Antepartum haemorrhage
• Multiple pregnancy
• PROM

Question 3

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

Answer 3

Transvaginal USS for cervical length

2nd line= Foetal fibronectin

Vaginal swab for infections

Question 4

A foetal fibronectin level ______ indicates a _______ chance of labour

Answer 4

<50ng/mL = unlikely in labour

Question 5

What two markers are investigated for in premature rupture of membranes

Answer 5

Placental Alpha-microglobulin- 1 (PAMG-1)

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

Question 6

Tocolysis is indicated in pre-term labour that is…

Answer 6

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

Question 7

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

Answer 7

Tocolysis

- Nifedipine

Question 8

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

Answer 8

Atosiban

Question 9

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

Answer 9

Corticosteroids

- Fetal lung development

Question 10

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

Answer 10

Magnesium sulfate IV,

weeks 24-34

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

Question 11

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

Answer 11

Breech, <32 weeks

Question 12

What medication is given in PROM

Answer 12

Erythromycin 250mcg 10 days/ until labour

Antenatal steroids from 24 weeks

Question 13

At what gestational age is delivery considered for PROM

Answer 13

34 weeks

Question 14

Extreme preterm is defined as gestation age…

Answer 14

<28 weeks

Question 15

Medical prophylaxis for preterm labour

Answer 15

Vaginal progesterone (gel/ pessary)
- Decreases contraction activity

Question 16

Vaginal progesterone is offered as prophylaxis for preterm labour when…

Answer 16

Cervical length <25 mm in USS 16-24 weeks

Question 17

Surgical prophylaxis for preterm labour

Answer 17

Cervical cerclage

Question 18

Cervical clerage is offered for preterm labour when…

Answer 18

Cervical length< 25nn on USS 16-24 weeks

Previous preterm labour

Cervical trauma (i.e. cone biopsy)

Question 19

Cervical clerage is offered for preterm labour when…

Answer 19

Cervical length< 25nn on USS 16-24 weeks

Previous preterm labour

Cervical trauma (i.e. cone biopsy)

Question 20

Rescure clerage involves…

Answer 20

Stitching the cervix to offer support in cervical dilation without ROM

Weeks 16-27+6

Question 21

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

Answer 21

> 15mm, >30 weeks gestation

Question 22

Mechanism of atosiban

Answer 22

Oxytocin receptor antagonist

- Stops uterine contractions

Question 23

Risk factors for umbilical cord prolapse

Answer 23

Most significant= Abnormal lie >37 weeks

Polyhydroaminos

Multiparity

Low lying placenta

Small baby

Long umbilical cord

Artificial amniotomy

Question 24

Complications of cord prolapse

Answer 24

Foetal hypoxia –> brain damage –> death

Question 25

Examination for cord prolapse

Answer 25

CTG - Shows fetal distress Speculum/ internal vaginal exam - Cord prolapse visible

Question 26

Acute management of cord prolapse

Answer 26

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

Question 27

Emergency C-section is indicated in cord prolapse when

Answer 27

Abnormal foetal HR Occult prolapse (cord alongside fetus)

Question 28

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

Answer 28

30 mins

Question 29

Breech is likely to spontaneously resolve by...

Answer 29

36 weeks

Question 30

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

Answer 30

40

Question 31

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

Answer 31

External cephalic version 36 for primigravida 37 weeks for multiparous

Question 32

External cephalic version has a ____% success rate

Answer 32

50-60%

Question 33

______ should be given in _____ mothers during ECV

Answer 33

Anti-D immunoglobulins for Rh-D negative mothers

Question 34

The most common breech presentation is...

Answer 34

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

Question 35

Risk factors for breech

Answer 35

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

Question 36

Complications of breech presentation

Answer 36

Umbilical cord prolapse

Question 37

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

Answer 37

- Low risk of early neonatal morbidity and perinatal mortality for babies

Question 38

Contraindications for external cephalic version [6]

Answer 38

Where C-section is required Post-partum haemorrhage within the last 7 days Abnormal CTG Major uterine anomaly Ruptured membranes Multiple pregnancy