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Obstetrics > Intrapartum: Pre-Term, PROM, PPROM, Prolonged > Flashcards

Intrapartum: Pre-Term, PROM, PPROM, Prolonged Flashcards

1
Q

Define pre-term labour

A

Labour before 37W

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2
Q

What are 5 risk factors for pre-term labour

A
  1. Previous pre-term
  2. Miscarriage
  3. Multiple pregnancy
  4. Uterine anomalies
  5. Pre-eclampsia
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3
Q

If associated with cervical weakness, how may pre-term labour present

A

Bulging membranes
Vaginal discharge
Abdominal pain

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4
Q

If associated with infection, how may pre-term labour present

A

Pain
Fever
Pain

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5
Q

What investigations is important for pre-term labour

A

Foetal fibronectin

USS

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6
Q

What should be given if pre-term labour

A

IM Corticosteroids (betamethasone)

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7
Q

What dose of corticosteroids are given

A

12mg/24h

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8
Q

What is the advantage of corticosteroids

A

Reduce respiratory distress syndrome, intra-ventricular haemorrhage

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9
Q

What may be considered if pre-mature labour

A

Tocolytics

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10
Q

If labour is confirmed what should be given

A

Magnesium

IV Antibiotics

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11
Q

Why is magnesium (4g) given

A

To reduce risk cerebral palsy

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12
Q

Define pre-mature rupture of membranes (PROM)

A

Rupture of membranes one hour prior to labour in foetuses more than 37W

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13
Q

What is pre-term pre-mature rupture of membranes (PPROM)

A

Rupture of membranes one hour before labour in foetus less than 37W

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14
Q

What increases risk of PPROM

A

Smoking

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15
Q

What increases risk of PROM

A 
Uterine anomalies 
Cervical weakness 
Previous PROM 
Polyhydramnios 
Infection 
Amniocentesis
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16
Q

How will PROM present

A

‘Waters break’ = ‘pop’ followed by water

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17
Q

Explain vaginal examinations in women with PROM labour

A

Do not perform a vaginal exam until confirmed women is in labour, Otherwise this increases risk of ascending infection which may cause women to enter labour quicker than if otherwise

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18
Q

How is diagnosis or PROM usually made

A

Clinically

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19
Q

What should be taken in all women with PROM

A

High vaginal swab to exclude group B streptococcus

20
Q

What is fernig test and what can it be used for

A

Cervical discharge smeared on glass slide - if positive fern shape will be present. Can be used to confirm ROM

21
Q

What can be looked for in secretions to determine if membranes ruptured

22
Q

What typically happens to women with PROM

A

Enter labour 24-48h later

23
Q

If PPROM happens before 33W what is done (4)

A
  1. Monitor for chorioamnionitis
  2. Avoid sexual intercourse
  3. Erythromycin
  4. Corticosteroids
24
Q

If PPROM happens 34-36W what is offered (6)

A
  1. Monitor chorioamnionitis
  2. Erythromycin
  3. Swab for group B strep - if positive give clindamycin in labour
  4. Steroids (34 - 34+6W)
  5. IOL
25
If PROM happens >37W what is done
1. Monitor chorioamnionitis 2. Clindamycin if GBS isolated 3. Wait 24h. If nothing, IOL
26
How long can women wait after PROM to spontaneously enter labour
96h
27
What is main complication of PROM
Chorioamnionitis
28
What other complication can PROM lead to
Oligohydramnios causing pulmonary hypoplasia
29
What is neonatal respiratory distress syndrome
Lung disorder due to deficiency in surfactant
30
What is the main risk factor for respiratory distress syndrome
Pre-maturity
31
What maternal condition can increase the risk of neonatal respiratory distress syndrome
Diabetes mellitus
32
How will neonatal respiratory distress syndrome present clinically
Onset of grunting at birth
33
What is the role of surfactant
Reduces alveolar surface tension - keeping them open
34
When does surfactant production occur
24W
35
When is surfactant distributed throughout the lungs
28W
36
When does surfactant reach sufficient concentrations and what does this mean
35W. Babies born before this (pre-mature) are at risk of respiratory distress syndrome
37
What is used to prevent neonatal respiratory distress syndrome
Antenatal corticosteroids
38
What is used to manage neonatal respiratory distress syndrome
Endotracheal surfactant | Oxygen (85%) increase gradually
39
What defines prolonged pregnancy
Pregnancy lasting >42W
40
What increases risk prolonged pregnancy
Previous history FH Maternal age >40
41
What is offered at 41W in prolonged pregnancy
Membrane sweep
42
What is offered at 41-42W in prolonged pregnancy
IOL
43
What are risks of prolonged pregnancy
``` Meconium aspiration IUGR Foetal distress Perinatal mortality Oiligohydramnios ```
44
What is foetal post-maturity syndrome
Used to describe post-term infants that present with malnutrition
45
How will babies with foetal post-maturity syndrome present
Scaphoid abdomen Little SC Fat Peeling skin over hands and feet

Obstetrics (27 decks)

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