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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

A

IGFBP-1

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
Q

If PROM happens >37W what is done

A
  1. Monitor chorioamnionitis
  2. Clindamycin if GBS isolated
  3. Wait 24h. If nothing, IOL
26
Q

How long can women wait after PROM to spontaneously enter labour

A

96h

27
Q

What is main complication of PROM

A

Chorioamnionitis

28
Q

What other complication can PROM lead to

A

Oligohydramnios causing pulmonary hypoplasia

29
Q

What is neonatal respiratory distress syndrome

A

Lung disorder due to deficiency in surfactant

30
Q

What is the main risk factor for respiratory distress syndrome

A

Pre-maturity

31
Q

What maternal condition can increase the risk of neonatal respiratory distress syndrome

A

Diabetes mellitus

32
Q

How will neonatal respiratory distress syndrome present clinically

A

Onset of grunting at birth

33
Q

What is the role of surfactant

A

Reduces alveolar surface tension - keeping them open

34
Q

When does surfactant production occur

A

24W

35
Q

When is surfactant distributed throughout the lungs

A

28W

36
Q

When does surfactant reach sufficient concentrations and what does this mean

A

35W. Babies born before this (pre-mature) are at risk of respiratory distress syndrome

37
Q

What is used to prevent neonatal respiratory distress syndrome

A

Antenatal corticosteroids

38
Q

What is used to manage neonatal respiratory distress syndrome

A

Endotracheal surfactant

Oxygen (85%) increase gradually

39
Q

What defines prolonged pregnancy

A

Pregnancy lasting >42W

40
Q

What increases risk prolonged pregnancy

A

Previous history
FH
Maternal age >40

41
Q

What is offered at 41W in prolonged pregnancy

A

Membrane sweep

42
Q

What is offered at 41-42W in prolonged pregnancy

A

IOL

43
Q

What are risks of prolonged pregnancy

A 
Meconium aspiration 
IUGR
Foetal distress 
Perinatal mortality 
Oiligohydramnios
44
Q

What is foetal post-maturity syndrome

A

Used to describe post-term infants that present with malnutrition

45
Q

How will babies with foetal post-maturity syndrome present

A

Scaphoid abdomen
Little SC Fat
Peeling skin over hands and feet

Obstetrics (27 decks)

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