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MRCOG Part 2 > Management of Labour > Flashcards

Management of Labour Flashcards

1
Q

How should women be counselled if GBS was detected in a previous pregnancy?

A

The likelihood of GBS carriage in this pregnancy is 50%. They should have the option for IAP or testing in late pregnancy followed by IAP if GBS still detected

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2
Q

If testing for GBS is planned, when should it be carried out?

A

35-37 weeks or 3-5 weeks prior to the anticipated delivery date

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3
Q

How should GBS UTI be managed?

A

The woman should receive antibiotics at the time of diagnosis, as well as IAP

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4
Q

How should IOL be managed differently for women with GBS?

A

GBS status should not affect method of induction of labour
GBS is not a contraindication to a membrane sweep

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5
Q

How should term PROM be managed in women with GBS?

A

They should be offered IAP and immediate induction of labour

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6
Q

How should preterm labour be managed for women without GBS colonisation?

A

Women in preterm labour should be offered IAP

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7
Q

Can a woman with GBS have a waterbirth?

A

Birth in a pool is not contraindicated in women with GBS as long as they have IAP

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8
Q

How should women known to have GBS be managed if they have PPROM?

A

Before 34 weeks, the risks of prematurity outweigh the risks of GBS. If >34 weeks, it may be beneficial to expedite delivery if the woman is known to have GBS

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9
Q

Which antibiotic should be given for IAP in women with penicillin allergy?

A

If not severe allergy: Cephalosporin
If severe allergy: Vancomycin

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10
Q

How should women who decline IAP be managed?

A

They should be advised the baby will need close monitoring for 12 hours and they should be strongly discouraged from an early discharge home

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11
Q

How should well babies at risk of early onset GBS disease whose mothers have not had IAP be managed?

A

They should have obs at 0, 1 and 2 hours, then 2 hourly til 12 hours

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12
Q

How should a baby with clinical signs of early onset GBS disease be managed?

A

They should be treated with Penicillin and Gentamicin within 1 hour

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13
Q

What is the rate of stillbirth in the UK?

A

1 in 200 babies are born dead

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14
Q

How should you manage the situation of a mother feeling fetal movement after diagnosis of an IUD on scan?

A

A repeat scan should be offered

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15
Q

How should testing to identify DIC be carried out in women choosing expectant management of late intrauterine fetal death?

A

Clotting, platelets and fibrinogen should be measured twice daily in women choosing expectant management of IUD

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16
Q

What is the prevalence of Factor V Leiden?

A

5%

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17
Q

How should women with intrauterine fetal death who are Rhesus negative be managed?

A

They should have an urgent Kleihauer to identify recent fetal maternal haemorrhage ad should be given immediate Anti-D

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18
Q

How should large fetomaternal haemorrhage resulting in intrauterine fetal death be managed?

A

The dose of Anti-D should be increased and the Kleihauer should be repeated at 48 hours

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19
Q

What is the optimal timing of Anti-D administration?

A

72 hours

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20
Q

How should fetal infection be investigated for in late intrauterine fetal death?

A

With cord or cardiac blood

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21
Q

In late intrauterine fetal death, how should uncertainty about fetal sex on examination be managed?

A

rapid karyoptying with PCR or FISH should be offered

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22
Q

What percentage of stillborn babies will have a chromosomal abnormality?

A

6%

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23
Q

Which tissue type is the most likely to result in unsuccessful culture for karyotyping?

A

Skin

24
Q

What is the disadvantage of using placental tissue for karyotyping?

A

There is a risk of pseudomosaicism

25
Q

Fetal postmortem examination provides information useful in guiding management of subsequent pregnancy in what proportion of cases?

A

51%

26
Q

What proportion of placental histological examinations show a major contributer to the cause of IUFD?

A

88%

27
Q

What is the chance of maternal DIC within 4 weeks of IUD if choosing prolonged expectant management?

A

10%

28
Q

What dose of Mifepristone is recommended prior to Misoprostol for induction of labour in IUD?

A

200mg

29
Q

What dosing regime of Misoprostol does NICE recommend for IOL in IUD?

A
  1. 100 micrograms 6 hourly before 26+6 weeks
  2. 25-50 micrograms 4 hourly at 27/40 or more
30
Q

What should women with more than 1 uterine scar be advised about IOL for IUD?

A

Women with 2 previous LSCS should be advised that the absolute risk of IOL for IUD is low

31
Q

Which opioid analgesia should be used in IOL for IUFD?

A

Diamorphine or regional analgesia

32
Q

What advice should women with late IUFD be given about non-pharmacological methods of milk suppression?

A

Almost 1 third are troubled by unacceptible discomfort

33
Q

What medication should be used for milk suppression in IUD and when is it contraindicated?

A
  1. Cabergoline should be used for milk suppression
  2. It is contraindicated for women with hypertension or pre-eclampsia
34
Q

What is different about fertility after IUD?

A

Fertility may return more quickly than following a live birth, especially if lactation suppression is used

35
Q

What additional investigations should women have in a pregnancy following IUD?

A

They should be offered screening for GDM

36
Q

Below what gestation must Ventouse delivery be avoided and why?

A
  1. Must avoid before 32 weeks gestation
  2. Use with caution before 36 weeks gestation

Both because of increased risk of subgaleal haemorrhage

37
Q

What is the guidance for Ventouse birth when the head is not born after three pulls?

A

3 further gentle pulls can be considered if the head is already on the perineum

38
Q

What are the rules for discontinuation of forceps birth?

A
  1. Discontinue if they cannot be applied easily
  2. Discontinue rotational forceps if rotation is not achieved with gentle pressure
  3. Discontinue if birth is not imminent after 3 pulls
39
Q

What is the guidance on antibiotic prophylaxis following asssited vaginal birth?

A

A single dose of Co-Amoxiclav should be given prophylactically

40
Q

What is the reported incidence of shoulder dystocia? (range)

A

0.58-0.7%

41
Q

What is the incidence of PPH following shoulder dystocia?

A

11%

42
Q

What is the incidence of OASI following shoulder dystocia?

A

3.8%

43
Q

What is the incidence of brachial plexus injury following shoulder dystocia? (range)

A

2.3-16%

44
Q

What percentage of brachial plexus injuries result in permanent disability?

A

Fewer than 10%

45
Q

What is the relationship between maternal diabetes and shoulder dystocia?

A

Infants of diabetic mothers have a 2 to 4-fold increased risk of shoulder dystocia compared to babies of the same weight born to non-diabetic mothers

46
Q

What are the prelabour risk factors for shoulder dystocia?

A

Macrosomia (EFW >4.5Kg)
Maternal diabetes
maternal BMI >30
Previous shoulder dystocia
Induction of labour

47
Q

What are the intrapartum risk factors for shoulder dystocia?

A

Prolonged first stage of labour
Secondary arrest
Prolonged second stage of labour
Oxytocin augmentation
Assisted vaginal delivery

48
Q

What is the role of induction of labour in prevention of shoulder dystocia?

A
  • Induction of labour does not reduce the risk of shoulder dystocia for women with a macrosomic fetus in the absence of diabetes
  • Women with diabetes and a normally grown baby should be offered IOL or ELCS after 38 weeks to reduce the risk of shoulder dystocia
49
Q

What is the relative risk of shoulder dystocia in a woman with previous shoulder dystocia compared to the general population?

A

10 times higher

50
Q

What is the recurrence rate of shoulder dystocia? (range)

A

1-25%

51
Q

What is the incidence of humeral fractures following delivery of the posterior arm at shoulder dystocia? (range)

A

2-12%

52
Q

What is the risk of emergency hysterectomy with placenta praevia?

A

Up to 11 in 100

53
Q

What is the risk of recurrent placenta praevia?

A

23 in 100

54
Q

What is the risk of massive obstetric haemorrhage with placenta praevia?

A

21 in 100

55
Q
A

MRCOG Part 2 (10 decks)

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