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Obstretics > Labour > Flashcards

Labour Flashcards

1
Q

Maternal Causes of preterm labour

A

PPROM, uterine stretch, cervical insufficiency, APH, infection, trauma, IOL

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2
Q

Fetal causes of preterm labour

A

IUGR, aneuploidy, structural malformations

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3
Q

Risks of giving oxytocin to induce labour

A

Uterine hyper stimulation, amniotic fluid embolism, water intoxication

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4
Q

When to do fetal fibronectin?

A

When cervix <3cm dilated, not in active labour, not ROM

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5
Q

How to diagnose preterm labour?

A

If regular, powerful contractions
Cervix is dilated to 4 or more cm
Or cervical dilation

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6
Q

Causes of OP position

A
  1. Android/anthropoid type pelvis

2. Use of intrapartum epidural analgesia due to relaxation of the pelvic floor muscles - it can’t rotate anteriorly

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7
Q

How to manage OP position in labour?

A
  1. Closely monitor progress and fetus (CTG)
  2. Use oxytocin to maintain 3-4 contractions every 10 minutes, will help rotation to OA
  3. Can use instrumental delivery
  4. If failure to progress/CTG abnormality, C section needed
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8
Q

What to do when you diagnose TAPS?

A

Follow up for MCA PSV within 24 hours

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9
Q

Maternal risks in multiple pregnancy (antenatal)

A

IDA, backache, GERD, hyperemesis gravidarum
APH, preeclampsia, GDM, GHTN, miscarriage
PPROM, preterm labour

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10
Q

Maternal risks multiple pregnancy (intra and postpartum)

A

Operative delivery, cord prolapse, PPH, postpartum depression

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11
Q

What are the antibiotics given for PPROM?

A
  1. Erythromycin 250MG PO QID for 10 days/till labour starts

2. Ampicillin 2g IV 6hrly for 2 days, then amoxicillin 250mg PO TDS for 5 days + erythromycin as above

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12
Q

When to do active management for PROM?

A

GBS +ve, SROM > 96 hours, meconium staining, chorioamnionitis, abnormal CTG, breech/malpresentation, multiple pregnancy

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13
Q

Definition of macrosomia

A

Above 90th percentile/4.5kg (Aussie)

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14
Q

When can you use low/mid cavity forceps

A

Fetal head 1/5th palpable per abdomen
Leading point of skull is above station + 2cm but NOT above ischial spines
Rotation of 45 or less

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15
Q

Postnatal care for instrumental delivery

A 
Prophylactic antibiotics 
Thromboprophylaxis 
Analgesia 
Indwelling catheter for 12 hours
Pelvic floor exercises
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16
Q

Early and intermediate risks for C-section

A 
Maternal 
- PPH
- damage to bowel, bladder, ureters 
- anesthesia
- wound hematoma 
Fetal
- TTN
- laceration

Intermediate

  • infection
  • VTE
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17
Q

Late risks for C-section

A 
Urogenital fistula 
Adhesion
Uterine rupture with subsequent prev
Placental malpositioning
Ectopic pregnancy
Repeat C-section for subsequent pregnancy
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18
Q

How to diagnose PPROM/PROM

A

Sterile speculum

  • pooling of amniotic fluid
  • if not, do ActimProm
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19
Q

Investigations for PPROM/PROM

A

Vital signs
FBC, CRP
First-void urine for chlamydia and gonorrhea PCR
MSU for MC&S
Low vaginal and perianal swab if GBS unknown

20
Q

Ongoing maternal and fetal surveillance PPROM

A

Maternal
- 4-6 hourly temperature and pulse
- vaginal loss and uterine activity
- WCC 2x a week
- blood culture if chorio suspected, expedite birth
- woman must notify staff if feeling unwell, foul discharge, abdominal pain, change in fetal movements
Fetal
- CTG if more than 28 weeks, daily for 3 days then twice weekly
- BPP if less than 28 weeks, same

21
Q

Birth timing in PPROM

A

All women expedite at 37 weeks, expectant if less.

If chorio or compromise, hasten

22
Q

Intrapartum management of PPROM

A

If GBS, treat accordingly
Continuous CTG
Neonataology/paeds attend birth
Sent placenta and swabs for HPE

23
Q

PPROM management flow

A 
History 
Diagnosis 
Investigations
Antibiotics
CS/MGSO4
Ongoing surveillance
Outpatient 
Birth timing
Intrapartum mx 
Postnatal observation
24
Q

When can discharge PPROM and indications

A

After admitted for 3 days, if got access to hospital, support at home, no signs of labour, no infection, no risk factors, no fetal compromise, gestational age

25
Q

Expectant management for PROM

A

Book IOL within 96 hours after SROM or earlier if woman chooses
LVS and perianal swab for GBS if required
Review as outpatient every 48 hours
- CTG
- maternal vitals
- vaginal loss, abdominal pain and tenderness
If spontaneous labour, CTG at 24 hours after SROM

26
Q

Bishop’s score cervical dilation and length scoring

A

0: 0cm/3
1: 1-2cm/2
2: 3-4cm/1
3: 5+/0

27
Q

Bishop’s score cervical length scoring

A

0: 3cm
1: 2cm
2: 1cm
3: 0cm

28
Q

Bishop’s score station scoring

A

0: -3
1: -2
2: -1,0
3: +1 onwards

29
Q

Bishop’s score cervical consistency scoring

A

0: firm
1: medium
2: soft

30
Q

Bishop’s score cervical position

A

0: posterior
1: mid
2; anterior

31
Q

Contraindications to using vaginal pessary or vaginal gel to IOL

A

Multiparity > 3, unexplained vaginas bleeding, fetal compromise, previous c-section, major uterus surgery, asthma, hypersensitivity to PGE

32
Q

Risks of using PGE2 for IOL

A

Uterine hyperstimulation, GI upset, uterine rupture, placenta abruptio

33
Q

Which is the recommended episiotomy

A

Mediolateral at 60 angle to midline

34
Q

Which sphincter injury causes fecal urgency and which causes fecal incontinence

A

External

Internal

35
Q

Antenatal management of multiple pregnancy

A

High dose folate supplement and iron!

11-13 weeks: dating scan to determine chorionicity and assign nomenclature to fetus, as usual with others
20-22 week: anatomy scan

MCDA: fortnightly ultrasound from 16 weeks to monitor for TTTS and sFGR

DCDA: monthly scan from 24 weeks

Visits

  • monthly till 30 weeks
  • fortnightly till 34
  • weekly after 34
36
Q

Delivery timing and mode

A

DCDA: 37-38 weeks
MCDA: 36-37 (need betamethasone)
MCMA: 32-34

DCDA and MCDA: 
- vaginal of presenting twin cephalic, no complications, no size difference 
- epidural in case need IPV for breech 
- mom can choose c section 
MCMA: always c section 
Triplets and above: always c section
37
Q

Monochorionic twins risk

A
  1. Twin-twin transfusion syndrome (TTTS)
    - placenta laser ablation to disrupt anastomosis
    - serial amnioreduction every 1-2 weeks
  2. Twin reversed arterial perfusion sequence (TRAPS)
    - cord ligation
  3. Selective FGR
  4. Twin anemia-polycythemia sequence (TAPS)
    - need to follow up with u/s for MCA PSV within 24 hours once detected

MCMA: cord entanglement (need to deliver early by c-section)

38
Q

Maternal risks of multiple pregnancy

A

Antenatal:
IDA, GERD, backache, hyperemesis gravidarum
APH, GHTN, preeclampsia, GDM, miscarriage

Intrapartum and postpartum:
PROM, preterm labour, operative delivery, cord prolapse
PPH, breastfeeding, postpartum depression

39
Q

Contraindications to vacuum delivery

A

Relative

  • fetal bleeding disorders
  • predisposition to fracture

Absolute

  • <34 weeks due to risk of ICH
  • face presentation
40
Q

Outlet forceps (Wrigley’s) indications

A

fetal scalp visible without separating labia
fetal skull reached pelvic floor
rotation does not exceed 45
fetal head at or on perineum

41
Q

Low/mid cavity forceps aka Neville Barnes, Anderson, Simpson

A

fetal head one-fifth palpable per abdomen
leading point of skill is above station + 2cm but not above ischial spines
rotation 45 or less

42
Q

When to admit for preterm labour

A

Admit if:
fFn 50ng/ml or more
Cervical dilation/change after 2-4 hours, cervix length <15 mm
ROM/regular painful contraction/other concern

43
Q

When is tocolysis needed for preterm labour and what are they

A

If risk of birth within 7 days, to allow for CS administration or if need transfer

Nifedipine, salbutamol, indomethacin

44
Q

When to discharge if threatened preterm labour and when to follow-up

A 
Normal maternal vitals 
No chorioamnionitis 
Infrequent contractions 
No cervical change 
Normal CTG 
FFN negative

must follow-up in one week and tell signs of PTL, risk reduction, how and when to seek clinical advice

45
Q

Contraindications for ECV

A 
Maternal: previous scar, high-risk mom
Placenta: previa 
Fetal: IUGR, malformation, multiple preg, footling breech 
Fetomaternal: Rh incompatibility 
ROM 
Abnormal CTG
46
Q

Procedure for breech

A

Admit mother and perform examination and investigations
Maternal: FBC, ECG, blood group, rhesus
Fetal: CTG, USG, amniotic fluid vol
NBM
Don’t empty bladder
Administer tocolytics
- SC terbutaline 250microgram or nifedipine 20mg oral

During:

  • feel slight discomfort
  • monitor FHR a intermittently

After

  • Kleihauer
  • give anti-D IgG
  • perform CTG: if abnormal, PV bleed, unexplained pain, expedite birth
  • if successful, monitor for a day
  • come back for abdominal USG after a week
47
Q

What maneuver is performed in breech delivery

A

Lovset’s

Obstretics (8 decks)

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