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Toronto Notes 2019 Abnormalities and Complications of Labour and Delivery
Management
• shouldbemanagedintheICUbyamultidisciplinaryteam
• supportivemeasures(highflowO2,ventilationsupport,fluidresuscitation,inotropicsupport,±
intubation), coagulopathy correction
Chorioamnionitis
Definition
• infectionofthechorion,amnion,andamnioticfluidtypicallyduetoascendinginfectionbyorganisms of normal vaginal flora
Etiology/Epidemiology
• incidence1-5%oftermpregnanciesandupto25%inpretermdeliveries
• ascendinginfection(microorganismsfromvagina)
• predominantmicroorganismsinclude:GBS,BacteroidesandPrevotellaspecies,E.coli,andanaerobic
Streptococcus
Risk Factors
• lowparity,prolongedROM,longlabour,multiplevaginalexamsduringlabour,internalmonitoring • bacterialvaginosisandothervaginalinfections
Clinical Features
• maternalfever≥39oC,maternalorfetaltachycardia,uterinetenderness,foulandpurulentcervical discharge
Investigations
• CBC: leukocytosis
• amnioticfluid:Gramstain,glucose,orcultureresultsconsistentwithinfection
Treatment
• IVantibiotics
■ ampicillin 2 g IV q6h and gentamicin 2 mg/kg load and then 1.5 mg/kg IV q8h or 5 mg/kg IV q24h ■ anaerobic coverage (i.e. clindamycin 900 mg IV q8h)
■ if at risk for endometritis, continue treatment post-partum especially if C/S delivery
• antipyretics
• properlabourprogression(notanindicationforimmediatedeliveryorC/S)
Complications
• bacteremiaofmotherorfetus,woundinfectionifC/S,pelvicabscess,neonatalmeningitis,neonatal sepsis, neonatal death
• long-terminfantcomplications:cerebralpalsy,bronchopulmonarydysplasia
Meconium
Epidemiology
• presentearlyinlabourin10%ofpregnancies,morecommoninpostdatepregnancies
• ingeneral,meconiummaybepresentinupto25%ofalllabours;usuallyNOTassociatedwithpoor
outcome, but extra care is required at time of delivery to avoid aspiration
• concerniffluidchangesfromcleartomeconium-stained
• always abnormal if seen in preterm fetus
Etiology
• likelycordcompression±uterinehypertonia
• mayindicateundiagnosedbreech
• increasingmeconiumduringlabourmaybeasignoffetaldistress
Features
• maybewateryorthicker(particulate)
• lightyellow/greenordarkgreen-blackincolour
Treatment
• callrespiratorytherapy,neonatology,orpediatricstodeliveryroom • closelymonitorFHRforsignsoffetaldistress
Obstetrics OB41
Clinical Features of Chorioamnionitis
• Temperature
• Tachycardia (maternal or fetal) • Tenderness (uterine)
• Foul discharge
Particulate (thickened) meconium is associated with lower APGARs, an increased risk of meconium aspiration, and perinatal death. Particulate meconium generally has
a darker green or black colour, whereas thin meconium is usually yellow to light green