delivery disorders

Question 1

presentation of foetal distress

Answer 1

• Foetal tachycardia or bradycardia
• Decelerations
• Loss of variability
• Low pH and High lactate on FBS

Question 2

risk factors of foetal distress

Answer 2

• Induction of Labour
• Prolonged labour
• Pre-eclampsia
• Gestational diabetes
• Obesity
• Multiple gestation
• IUGR

Question 3

management of foetal distress

Answer 3

ABC - IV fluids and oxygen
delivery guided by investigations (CTG and FBS)

Question 4

risk factors of breech presentation

Answer 4

• Polyhydramnios
• Foetal abnormalities
• Multiple gestation

Question 5

investigations and management of breech presentation

Answer 5

USS to confirm foetal position and CTG to monitor for foetal distress

watch and wait
external cephalic version ECV (manual turning of foetus)
discuss and inform about risks of vaginal vs c section

Question 6

types of preterm

Answer 6

mildly- 32-36
very - 28-32
extremely- 24-28

below 23 weeks baby is considered non viable. born at 23 weeks only 10% chance of survival

Question 7

causes of preterm labour

Answer 7

multiple gestation
preeclampsia
placental abruption
infection STI or UTI
cervical surgery

Question 8

complications of preterm labour

Answer 8

resp distress syndrome (give steroids)
higher risk of cerbral palsy (give IV mg sulfate)

Question 9

diagnosis of preterm labour

Answer 9

• Contractions with evidence of cervical change on vaginal examination
• Ultrasound of cervical length <15 mm suggestive of preterm labour
• Vaginal swab
  
  • Actim partus (after 22 weeks pregnancy)
  • Foetal fibronectin >50 ng/mL (from 30 weeks pregnancy)

Question 10

prevention of preterm labour

Answer 10

cervical cerclage in 2nd trimester
vaginal progesterone

Question 11

management of preterm labour if viable

Answer 11

tocolysis
IM betamethasone 24h apart if <26 weeks to allow foetal lung maturation
IV magnesium sulfate (protects foetal brain and reduces risk of cerebral palsy)

Question 12

management of PROM

Answer 12

admit for 48-72 hours
erythromycin for 10 days
consider steroids if <37 weeks (preterm PROM)
discuss appropriate mode of delivery

Question 13

investigations for PROM

Answer 13

speculum exam shows pooling of amniotic fluid and if it doesnt then IGF-1 or placental alpha microglobulin 1 test and should be pos for PROM
CTG

Question 14

cord prolapse investigation and diagnosis

Answer 14

descent of umbilical cord through cervix ahead of foetus with risk of compression resulting in foetal hypoxia

palpable cord on vaginal/spec exam
suspect if foetal distress on CTG

Question 15

management of cord prolapse

Answer 15

• Replace cord into vagina (not uterus)
  
  • Pushing the cord back in is not recommended. The cord should be kept warm and wet and have minimal handling whilst waiting for delivery (handling causes vasospasm).

digital elevation of the presenting part

Catheterise to Fill Bladder to elevate presenting part.

Knee-Chest or Left Lateral Position

Tocolysis (e.g. terbutaline)
- used to minimise contractions whilst waiting for delivery by c-section.

c section delivery

Question 16

causes of shoulder dystocia

Answer 16

macrosomia secondary to GDM
maternal obesity or rapid weight gain
overdue

Question 17

complciations of shoulder dystocia

Answer 17

foetal hypoxia
brachial plexus injury and erbs palsy
perineal tears
postpartum haemorrhage

Question 18

management of shoulder dystocia

Answer 18

H- call for help

E- episiotomy to reduce risk of perineal tears. not always necessary

L- legs (mcRoberts manoeuvre)

P- suprapubic pressure

E- enter/ rubin manoeuvre (internal rotation) (reaching into vagina to put pressure on posterior aspect of babys anterior shoulder to help it move under the pubic symphysis

R- remove posterior arm

R- roll the patient onto all fours