BIRTH COMPLICATIONS

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Questions and Answers

What is the gestational age range that defines pre-term labour?

15 – 25 weeks

30 – 40 weeks

10 – 20 weeks

20 – 37 weeks (correct)

Which of the following signs is NOT typically associated with pre-term labour?

Membrane rupture

Backache

Regular contractions or tightenings

Severe abdominal pain without bleeding (correct)

In cases of unknown gestation, what indicates that a woman is likely over 20 weeks pregnant?

The woman has no significant weight gain.

The woman experiences severe nausea.

The fundus is palpable at the umbilicus. (correct)

The woman reports decreased fetal movement.

What should be done if a pregnant woman over 20 weeks has no antenatal care?

Consider safeguarding and refer as necessary. Signup and view all the answers

What is the first critical assessment to make in the management of pre-term labour?

Determine if birth is imminent. Signup and view all the answers

Which position can be employed if there is a delay in transferring the mother to the ambulance?

Knees-chest position Signup and view all the answers

What should be done immediately after the birth of the first twin?

Clamp the cord of the first twin immediately Signup and view all the answers

What is a major concern associated with the delivery of breech births?

Increased risk of hypoxic injury with slow delivery Signup and view all the answers

Which of the following is true regarding management of multiple births?

Aim to get to the nearest obstetric unit regardless of the birth's imminence Signup and view all the answers

What is a common characteristic of breech births?

They are predominantly observed in pre-term and multiple births Signup and view all the answers

What is a primary sign that cord prolapse has occurred?

Umbilical cord visible at the vaginal opening Signup and view all the answers

Which of the following conditions is most likely to increase the risk of cord prolapse?

Multiple births Signup and view all the answers

What immediate action should be taken when managing a cord prolapse?

Gently replace the cord to the vulva with a clean dry pad Signup and view all the answers

Why is cord prolapse considered a time-critical emergency?

It causes fetal hypoxia due to compression Signup and view all the answers

What is one of the first actions to take in a pre-alert scenario before reaching the obstetric unit?

Request additional resources Signup and view all the answers

Which statement about the management of cord prolapse is incorrect?

Perform vaginal inspection without consent Signup and view all the answers

At what stage of gestation should proactive care for potential complications start?

From 22 weeks gestation and above Signup and view all the answers

What is a potential consequence of cord prolapse if not managed properly?

Fetal hypoxia leading to brain damage Signup and view all the answers

What does a footling breech presentation indicate?

The feet come out first without the buttocks following. Signup and view all the answers

When diagnosing shoulder dystocia, how is it determined?

The body is not born within two contractions after the head. Signup and view all the answers

What is the most critical action to take when a patient presents with shoulder dystocia?

Early pre-alert to the hospital is essential. Signup and view all the answers

Which approach should be avoided during a shoulder dystocia incident?

Pushing downwards on the mother's abdomen. Signup and view all the answers

What is a key takeaway from the management of breech births?

Hands should be poised to intervene if needed. Signup and view all the answers

What is NOT recommended when dealing with birth complications?

Calling for a midwife right away. Signup and view all the answers

Which of the following is NOT a characteristic of axial traction?

Involves moving the baby upwards. Signup and view all the answers

What should be prepared for when managing a breech birth?

NLS and/or PPH (Neonatal Life Support and/or Postpartum Hemorrhage). Signup and view all the answers

Study Notes

Pre-Term Labour

Pre-term Labour is defined as birth between 20-37 weeks gestation.
Assess gestation and whether birth is imminent.
If birth is imminent, prepare for birth on scene and notify EOC.
If birth is not imminent, pre-alert the nearest obstetric unit or ED with obstetrics onsite.
If the mother is visibly pregnant or the fundus is palpable at the umbilicus, the gestation is likely to be over 20 weeks.
Any pregnancy over 20 weeks without antenatal care requires safeguarding through EBS.
Signs of preterm labour include: regular contractions, period-type pain or pressure in the vagina, membrane rupture, backache. Bleeding after 20 weeks is a RED FLAG.
If birth is not imminent, reassess the mother continuously en route.
Survival focused care: Applicable for gestation 21+6 weeks and below.
Comfort care: Applicable for gestation 22 weeks and above, gestation unknown and eyes fused, gestation unknown and eyes not fused.

Cord Prolapse

Cord prolapse is when the umbilical cord exits the vagina prior to birth.
This commonly occurs with membrane rupture, especially in cases of pre-term labour, breech presentation, or multiple births.
The cord may be visible at the vaginal opening or felt by the woman.
Inspection with consent is necessary for diagnosis.
Cord prolapse is a TIME CRITICAL EMERGENCY.
Risks: The presenting part (head or buttocks) compressing the cord can cause fetal hypoxia, leading to brain damage or death.
Management: Pre-alert the nearest obstetric unit, minimise handling of the cord, gently replace it to the vulva using a clean dry pad, avoid re-inserting the cord into the vagina.
Assist the mother into an exaggerated SIMs position while transferring to the ambulance.
If there's a delay in transferring the mother to the ambulance, consider the knees-chest position (not for conveying).

Multiple Births

A lower threshold for conveyance is recommended if birth isn't imminent.
If birth occurs on scene, clamp the cord of the first twin immediately.
Thermoregulation is crucial due to the likelihood of pre-term/smaller babies.
There may be several minutes to hours between the birth of the first baby and subsequent babies.
Do not delay on scene.

Breech Birth

Breech birth occurs when the buttocks or feet present first.
It is more common in pre-term births and multiple births.
The longer the time from the birth of the buttocks to complete delivery, the greater the risk of hypoxic injury.
Interventions may be required if the birth is slow.
If the feet come out first and are not immediately followed by the buttocks, this is an emergency (Footling breech) and requires rapid transport to hospital.
Use the Maternity Action Tool checklist for management.
Prepare for NLS and/or PPH, and call for additional support (second crew, APP-CC, CTM, IRO).
Keep hands POISED, ready to intervene or receive the baby.
Set a timer as a delay indicates intervention is required.

Shoulder Dystocia

Shoulder dystocia occurs when the baby's head is born but the shoulders become stuck on the mother's pelvic bone, preventing the birth of the baby's body.
It's diagnosed if, after the head is born, the body is not born within the next two contractions.
Axial Traction: Apply steady pressure in a straight line (not upward or downward).
Use the Maternity Action Tool checklist for management.
Prepare for NLS and PPH.
Early pre-alert is essential.
Document the time of the head delivery and any maneuvers performed.
Avoid encouraging the woman to push or apply upward/downward/excessive traction.

Summary

Birth complications can be unpredictable, so call for help early in maternity cases.
Utilize the maternal assessment and obstetric emergencies cards on JRCALC+ to guide management.
Do not request a midwife during an obstetric emergency; this will delay care (unless the patient declines transfer).
Datix all birth complications.

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Description

This quiz covers the vital aspects of pre-term labour, including definitions, assessment criteria, and emergency actions required when faced with imminent birth situations. It also addresses the management of cord prolapse and associated complications. Test your knowledge on these critical obstetric emergencies!