Obstetrics Flashcards

Question

What is placental abruption?

Answer 1

Where part/all of your placenta separates from the wall of the uterus prematurely. Antepartum haemorrhage: vaginal bleeding from week 24 of gestation until delivery

Answer 2

Following a rupture of maternal vessels within the basal layer of the endometrium. Blood accumulates and split the placental attachment from the basal layer. The detached portion of the placenta is unable to function leading to rapid foetal compromise.

Answer 3

Revealed - bleeding tracks down from site and drains through cervix resulting in vaginal bleeding Concealed - bleeding remains in uterus forming a clot retroplacentally - bleeding not visible but can cause systemic shock

Answer 4

- Placental abruption in previous pregnancy - Pre-eclampsia/HTN disorder - Abnormal lie of foetus (transverse) - Polyhydraminos - Abdominal trauma - Smoking/drug use - Bleeding in 1st trimester - Thrombophilia - Multiple pregnancy

Answer 5

Antepartum haemorrhage. Painful vaginal bleeding. (If in labour, enquire about pain between contractions) Woody uterus (tense all the time) Uterus painful on palpation.

Answer 6

- Placenta praevia - Marginal placental bleed (small, partial abruption not large enough to cause maternal/foetal compromise) - Vasa praevia - Uterine rupture - Benign/malignant lesions (polyps/carcinoma/cervical ectropion) - Infections (candida/BV/chlamydia)

Answer 7

Process of starting labour artificially. Most women will go into spontaneous labour by week 42 of gestation, 1 in 5 will require an induction. Performed when the baby will be safer delivered rather than remaining in utero, or for reasons concerning the mother's health.

Answer 8

Induction of labour should NOT be offered on maternal request alone. Prolonged gestation - Uncomplicated pregnancies offered IOL between 40+0 & 40+14 - Avoid foetal compromised and stillbirth associated with prolonged gestation - If IOL declined the frequency of monitoring from 42 weeks should be increased Premature rupture of the membranes - >37 weeks: offer IOL or offer expectant management for max 24 hours (any longer increases risk of chorioamnionitis) - <34 weeks: delay IOL unless obstetric factors indicate otherwise (foetal distress) - >34 weeks: timing of IOL depends on risks and benefits of delaying pregnancy further Maternal health problems - HTN - Pre-eclampsia - DM - Obstetric cholestasis Foetal growth restriction - 2nd most common indication for IOL - Deliver baby prior to foetal compromise IU foetal death - Labour offered if mother is well with intact membranes

Answer 9

Absolute - Cephalopelvic disproportion - Major placenta praevia - Vasa praevia - Cord prolapse - Transverse lie - Acute primary genital herpes - Previous classical C section Relative - Breech - Triplet or higher order pregnancy - 2 or Moe previous low transverse C sections If woman has had a previous C section, IOL can be offered after being assessed by the consultant. Mother should be made aware of increased risk of emergency C section and uterine rupture.

Answer 10

Vaginal prostaglandins - Primary method - Prostaglandins act to prepare the cervix for labour by ripening it, as well as helping the contraction of the smooth muscle of the uterus - Tablet/gel/controlled release pessary - 1 cycle in 24 hours recommended dose Amniotomy - Membranes ruptured artificially with an amnihook - This releases prostaglandins - Only performed when the cervix is ripe - Infusion of artificial oxytocin is given to increase strength and frequency of contractions (start low and titrate up until 4 contractions every 10 mins) - Not used as primary method Membrane sweep - Offered at 40 and 41 weeks to nulliparous women - 41 weeks for multiparous women - Adjunct of IOL - Performing it increases the likelihood of spontaneous delivery - Inserting a gloved finer through cervix and rotating it against foetal membranes aiming to separate the chorionic membrane from the decidua - The separation helps to release prostaglandins Lack of evidence for homeopathy, acupuncture and sexual intercourse.

Answer 11

Assessment of cervical ripeness. Checked prior to induction and during induction (6 hours post tablet/gel, 24 hours post pessary). - >/=7: cervix is ripe (high chance of response to interventions made to induce labour) - <4: labour unlikely to progress naturally and prostaglandin tablet/gel/pessary will be required Failure of cervix to ripen despite use of prostaglandins may result in the need for a C section

Answer 12

CTG - Reassuring foetal heart rate must be confirmed prior - After IOL, assess via continuous CTG monitoring until normal rate confirmed - Subsequently asses using intermittent auscultation - If oxytocin infusion is started, monitor with continuous CTG throughout labour

Answer 13

- Failure of induction - Uterine hyperstimulation (contractions last too long or frequent leading to foetal distress, managed with tocolytic agents e.g. terbutaline) - Cord prolapse (can occur at time of amniotomy, especially is foetal head is high) - Infection (risk reduced by using pessary) - Pain (more painful, often epidural analgesia is required) - Increased rate of further intervention vs spontaneous labour (C section, instrumental) - Uterine rupture

Answer 14

PROM (prelabour rupture of membranes) - rupture of membranes at at least 1 hour prior to onset of labour at >37 weeks P-PROM (pre-term prelabour rupture of membranes) - rupture of foetal membranes occurring at <37 weeks

Answer 15

Foetal membranes consist of chorion and amnion. they are strengthened by collagen and become weaker (via apoptosis and enzymes) at term in preparation of labour. In PROM and P-PROM a combination of factors lead to early weakening and rupture of the foetal membranes - Early activation of normal physiological processes (higher than normal levels of apoptotic markers and MMPs in amniotic fluid) - Infection (inflammatory markers weaken the membranes) - Genetic predisposition

Answer 16

Smoking Previous PROM/pre-term delivery Vaginal bleeding during pregnancy Lower genital tract infection Invasive procedures Polyhydramnios Multiple pregnancy Cervical insufficiency

Answer 17

Broken waters: painless popping sensation followed by a gush of watery fluid leaking from vagina (Could be gradual leakage or change in discharge) Speculum examination (no need to do if visible leakage) - Fluid draining from cervix and pooling in posterior vaginal fornix - Make sure woman has laid on couch for 30 mins to allow for pooling Lack of vaginal discharge (washed clean): ask woman to cough to see if she expels amniotic fluid

Answer 18

Digital vaginal examinations - avoid until woman is in active labour

Answer 19

Urinary incontinence Normal vaginal secretions of pregnancy Increased sweat/moisture around perineum Increased cervical discharge (infection) Loss of mucus plug Vesicovaginal vaginal fistula

Answer 20

Actim-PROM: swab test looking for IGFBP-1 (concentration is 100-1000x concentration of maternal serum) Amnisure: looks for PAMG-1 (high concentrations in amniotic fluid) USS only used if unclear results (reduced levels of fluid) High vaginal swab: GBS (would indicate abx in labour and give cause for PPROM)