Delivery & Fetal Medicine Flashcards
Alpha-fetoprotein (AFP) is a protein produced by
the developing fetus
Increased AFP
Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy
Decreased AFP
Down’s syndrome
Trisomy 18
Maternal diabetes mellitus
breech presentation is
the caudal end of the fetus occupies the lower segment.
Most babies who are breech at 28 weeks will not turn
false
around ?% of pregnancies at 28 weeks are breech it only occurs in ?% of babies near term
around 25% of pregnancies at 28 weeks are breech it only occurs in 3% of babies near term
Which type of breech is most common?
frank breech
What is frank breech
is the most common presentation with the hips flexed and knees fully extended.
What is footling breech?
A footling breech, where one or both feet come first with the bottom at a higher position, is rare but carries a higher perinatal morbidity
Risk factors for breech presentation
uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity (due to increased incidence earlier in gestation)
What complication is more common in breech presentations
cord prolapse
Management breech
if < 36 weeks: many fetuses will turn spontaneously
if still breech at 36 weeks NICE recommend external cephalic version (ECV)- this has a success rate of around 60%. The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women
if the baby is still breech then delivery options include planned caesarean section or vaginal delivery
‘Women should be informed that planned caesarean section carries a reduced/increased perinatal mortality and early neonatal morbidity for babies with a breech presentation at term compared with planned vaginal birth.’
reduced
‘Women should be informed that there is no evidence that the long term health of babies with a breech presentation delivered at term is influenced by how the baby is born.’
true
RCOG absolute contraindications to ECV:
where caesarean delivery is required antepartum haemorrhage within the last 7 days abnormal cardiotocography major uterine anomaly ruptured membranes multiple pregnancy
There are two main types of caesarean section:
lower segment caesarean section: now comprises 99% of cases
classic caesarean section: longitudinal incision in the upper segment of the uterus
Which indications for CS are NOT relative (absoulte indication)
absolute cephalopelvic disproportion
placenta praevia grades 3/4
What are relative indications for CS?
pre-eclampsia
post-maturity
IUGR
fetal distress in labour/prolapsed cord
failure of labour to progress
malpresentations: brow
placental abruption: only if fetal distress
vaginal infection e.g. active herpes, cervical cancer (disseminates cancer cells)
If placental abruption and fetus is dead CS is indicated
false
Deliver vaginally
placental abruption is absoulte indication for CS
false
only if fetal distress
The RCOG advise clinicians to make women aware of serious and frequent risks when undergoing CS
true
CS ‘Frequent’ risks maternal
persistent wound and abdominal discomfort in the first few months after surgery
increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies
readmission to hospital
haemorrhage
infection (wound, endometritis, UTI)
CS ‘Frequent’ risks fetal
lacerations, one to two babies in every 100
CS ‘Serious’ risks maternal
emergency hysterectomy need for further surgery at a later date, including curettage (retained placental tissue) admission to intensive care unit thromboembolic disease bladder injury ureteric injury death (1 in 12,000)
CS ‘Serious’ risks future pregnancies
increased risk of uterine rupture during subsequent pregnancies/deliveries
increased risk of antepartum stillbirth
increased risk in subsequent pregnancies of placenta praevia and placenta accreta)
Other complications which are recognised but not specificially mentioned in the RCOG document include;
(CS)
prolonged ileus
subfertility: due to postoperative adhesions
If a women has had a previous caesarean section due a factor such as fetal distress the majority of obstetricians would not/ would recommend a trial of normal labour
Why?
would
around 70-75% of women in this situation have a successful vaginal delivery
VBAC contraindications include
previous uterine rupture or classical caesarean scar
Indications for a forceps delivery include
fetal distress in the second stage of labour
maternal distress in the second stage of labour
failure to progress in the second stage of labour
control of head in breech deliver
Human chorionic gonadotropin (hCG) is produced by
first produced by the embryo and later by the placental trophoblast
HCG’s role?
Its main role is to prevent the disintegration of the corpus luteum
Measurement of hCG levels form the basis of many pregnancy testing kits
true