preterm labour and delivery grand round

8/14/2019 Preterm Labour and Delivery Grand Round

1/22

DELIVERY OF PRETERM

INFANT

J. Siekei OMogire

V. Maloba Awori


2/22

Patient Data

M. S. T. 22 yr old lady from Huruma

Date of Admission:06/07/2009

LNMP 12th

Jan, 2009 reliable?? Para 1+2 with no living child, Gravida

4

EDD 19th October, 2009 Gestation By Dates 25 weeks


3/22

History of presentingcondition

Complained of spotting for I day priorto admission

Patient on routine antenatal follow up@ the HRC

No History of lower abdominal pain,no drainage of liquor.

? Fetal movements


4/22

Was first seen 4 months ago @ GBD 10weeks Blood group B+ve, Hb 12g/dl

VDRL & PITC negative Urinalysis normal

Impression of BOH due cervicalincompetence was made

Plan then: Patient advised forMcDonalds stitch @ 16/40

She did not come back for booked

appointment


5/22

Obstetric history

Year Place of delivery

Gestation

Modeofdelivery

Outcome

1stpregnancy

2007 Hospital Term

SVD Female FSB

2ndpregnancy

2008 Hospital @ 18weeks

- Abortion

3rd

pregnancy 2008 Hospital @ 21weeks - Abortion

Para 1+2 with no living child, Gravida 4EDD 19th October, 2009Gestation By Dates 25 weeks

Puerperium normal


6/22

Gynecological history

LNMP 12th Jan, 2009

?


7/22

PMHx/FSHx/Personal Hx

PMSHx

Family Hx-

Married with no living children Form 4 leaver, housewife

Husband 29 year old, businessman


8/22

Summary

MTS, a 22yr old married lady, para1+2 with no living child, Gravida4,LNMP 12th Jan 09,EDD 18th October

09, GBD 25 weeks, presenting withspotting for 1 day PTA.


9/22

EXAMINATION

General exam recorded as normal

BP 100/70mmHg

ABDOMINAL EXAM No scars, striae gravidarum present

Fundal height @ 24 weeks,

presentation cephalic, engagement5/5, position LOA

No contractions felt

FHR 150/min


10/22


11/22

Impression made: Inevitable early pregnancy loss with

Bad obstetric history


12/22

Plan on 6th @ 10:30am

Admitted to RMBH Nurse in the delivery room with resuscitation

eqpt

IV fluids 1.5 litres N/saline

MgSO4 1g/hour

Buscopan 40 mg TDS

Dexamethasone 20mg IM stat

IV Ceftriaxone 2g OD Salbutamol infusion 1mg in N/saline, run for

6-8hrs

Monitor FHR quarter hourly

Inform neonatologist


13/22

Patient stable

Fetal heart rate reassuring (142 158/minute)

No contractions felt


14/22

2nd day/7th July @ 8:30am

FHR 164/min

MO review

Suggested Obstetric U/S to Confirm fetal status Gestation

Determine state of cervix

Patient given warm fluids to take &discouraged from voiding

@ 10:40am mild contractions,

taken for U/S


15/22

Investigations

U/S

single Intrauterine fetus, in cephalicpresentation, cervix wide open with

bulging membranes, gestation by femurlength and bi-parietal diameterapproximately 24 weeks

Impression: sonographic features ofinevitable abortion

Urinalysis Normal


16/22

@ 11:30 am Mild contractions noted

Neonatologist informed

Consultant review Manage as inevitable abortion @ 24 weeks

Allow natural labour

Manage 3rd stage actively

@ 1:30 pm Moderate contractions

Fetal heart sound spresent


17/22

@ 3:15pm Strong urge to push

Delivered SVD

Live male infant did not cry immediately APGAR score 4/1 ,5/5 ,8/10 ,8/20

Suctioned, ambubagged, kept warm

Admitted to NBU, Weighed in NBU 870g Placenta and membranes delivered

Minimal PV loss, about 100mls


18/22

Labor & delivery ctd

No drugs given to the mother

Perineum intact

Duration of labor (as recorded) 1st stage 12 hours 30 minutes

2nd stage 5mins

3rd stage 5mins

TOTAL = 12hours 40 mins Fundus below umbilicus, mother

stable, placenta not weighed


19/22

Baby progress Baby was given 0.25mg vitamin K IM

Respiratory rate 52breaths/min Heart rate 132 beats/min

Noted to be in respiratory

distress,with grunting. Had Flaring of alae nasi,severe chest

wall indrawing,with reduced air entry

bilaterally. In cardiovascular exam,had

peripheral cyanosis.

PLAN


20/22

Start IVF at 120mls/kg

Monitor vitalsPatient needs surfactant

Placed on CPAP


21/22

8th July

Patent (mother)stable

? Lochia, Fundal Height

Patient declined IV medications

10th July

Neonate had several apneic attacks Resuscitation done,with ambubag

Aminophylline at 5mg IV


22/22

Stopped breathing

No cardiac activity

Neonate certified dead at 5pm

Neonate passed away in NBU

Mother counseled

Discharged

preterm labour and delivery grand round

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