Labour + Delivery

Question 1

Before what week is considered preterm?

Answer 1

37

Question 2

How many stages of labour are there and what defines them?

Answer 2

1st stage = contractions -> 10cm dilated
2nd stage = 10cm -> baby
3rd stage = baby -> placenta

Question 3

What are the 3 phases seen in the 1st stage of labour? What defines them?

Answer 3

Latent phase = 0-3cm (progress 0.5cm an hour), irregular contractions
Active phase = 3-7cm (progress 1cm an hour), regular contractions
Transition phase = 7-10cm (progress 1cm an hour), strong and regular contractions

Question 4

What are the 4 main signs of labour?

Answer 4

Show = mucous plug falling out of cervix
Rupture of membranes
Contractions
Dilated

Question 5

What weeks gestation define: extreme preterm? Very preterm? Moderate to late preterm?

Answer 5

Extreme = <28 weeks
Very = 28-32 weeks
Moderate to late = >32 weeks

Question 6

What are the 2 methods of prophylaxis of preterm labour?

Answer 6

Vaginal progesterone
Cervical cerclage

Question 7

What is the use of vaginal progesterone and how does it work?

Answer 7

Gel/pessary that maintains pregnancy
Decreases the activity of the myomerium and prevents cervical remodelling

Question 8

What is cervical cerclage?

Answer 8

Stitch in cervix (need spinal/general anaesthesia to perform) to help maintain pregnancy in preterm labour
Stitch removed before labour

Question 9

What 3 things can help diagnose preterm pre labour rupture of membranes?

Answer 9

Amniotic fluid pooling on speculum
IGFBP1 (insulin-like growth factor-binding protein 1) is increased conc in amniotic fluid
PAMG1 (placental alpha micro globin 1) increased conc in amniotic fluid

Question 10

Why are prophylactic abx given in P-PROM?

Answer 10

To prevent chorioamnionitis

Question 11

What are the 2 main ways of diagnosing preterm labour with intact membranes?

Answer 11

Check dilation either with speculum or trans vaginal USS
Fetal fibronectin = >50ng/ml in labour

Question 12

What is tocolysis? What is first line and second line drug?

Answer 12

Medication to stop contractions
1. Nifepidine (CCB)
2. Atosiban (oxytocin receptor antagonist)

Question 13

What are maternal steroids given in preterm labour? What weeks gestation qualify for them?

Answer 13

To mature lungs and prevent respiratory destress syndrome
<36weeks

Question 14

Why is IV magnesium sulfate given in preterm labour? What weeks gestation qualify?

Answer 14

Protects fetal brain and decreases risk of cerebral palsy
<34 weks

Question 15

Why are mums who are given IV magnesium sulfate monitored every 4 hours? What are the signs to look out for? (3)

Answer 15

Magnesium toxicity
1 decreased Resp rate
2 decreased BP
3 absent reflexes