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LUFD and IOL - Labor and Delivery part2

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1)

A 30-year-old primagravida with a BMI of 28 is seen in the ante- natal clinic at 36 weeks
gestation following referral from the com- munity midwife with suspected ‘large-for dates’.An
ultrasound scan is arranged, which confirms the fetus to be large for gestational age.An oral
glucose tolerance test is arranged a few days later, which is normal.What is the correct
management?

2)

A 27-year-old primigravida presents at 35+3 weeks’ gestation with a headache and 24 hours of
no fetal movement. An IUFD and preeclampsia are diagnosed. Induction of labour is performed.
Four days a er delivery her BP is still very labile, and she continues to require second-line oral
therapy. She is troubled by lactation and breast pain.
What would be the best management for her?

3)

A lady is diagnosed with a confirmed intrauterine fetal death (IUFD). She is known to be GBS
positive.
Which drug is not indicated in the intrapartum care in this woman?

4)

A 23-year-old para 2 woman presented with vague abdominal pains when she was 29 weeks
pregnant. General and abdominal examination did not reveal any abnor- mality. She had a
normal BP. Fetal Doppler and CTG could not demonstrate the fetal heart. A real-time ultrasound
scan augmented with colour Doppler of the fetal heart and umbilical artery confirmed
intrauterine fetal demise. It also showed collapse of the fetal skull with overlapping bones.
These findings were confirmed by a second scan. She insisted she still feels fetal movements.
How will you handle the situation?

5)

. 29 year old PG with IUFD at 26weeks has been feeling unwell for few days . She has intact
membranes but the liquor is noted to be green at delivery. .what is most likely cause of fetal
loss .

6)

A 36-year-old woman comes to the labour ward with absent fetal movements for the last six
hours. She is 36 weeks pregnant. All investigations confirmed intrauterine death. She has had
two previous vaginal births. After counselling, she was still undecided about the period of
waiting before active intervention.
What is the incidence of the most serious complication if she waits for four or more weeks?

7)

A 39-year-old primigravida presents at 35 weeks’ gestation with a 48-hour history of absent fetal
movement. An IUFD is diagnosed on ultrasound scan. She is otherwise t and well and
antenatal care has been unremarkable until this point. Labour is induced and a macerated
stillborn male weighing 2534 g is delivered. T e couple consent to postmortem.
Which of the following would be part of the initial investigations?

8) When diagnosing intrauterine fetal death what is the optimal method of diagnosis?

9) Pregnant with iufd at 26wks what will be the best regime to induce labour

10)

40 year old PG is unfortunately as having an iUFD at 40 weeks . Cervical examination shows
bishop score of 2. She is worried about the side effects of methods of induction.
What is the most cost effective method of induction

11) Which of the following statements about intrauterine fetal deaths is false?

12)

A 27 year old patient is referred to hospital due to cessation of fetal movements at 30 weeks
gestation. Tests confirm intrauterine fetal death (IUFD). Following discussion the patient
decides on expectant management. What would you advise regarding monitoring?

13)

A 35-year-old para 3 (previous SVDs) at 39 weeks’ gestation presents with no fetal movements,
and a diagnosis of IUFD is made. She is given mifepristone and then returns 2 days later for
misoprostol to induce labour. Repeated doses are given until contractions commence.
Contractions develop quickly but she then reports severe continuous pain. On assessment she
is profoundly shocked with a tender abdomen and profuse vaginal bleeding. She is taken to
theatre and a laparotomy is performed. T e abdomen has 4 L of blood, and the uterus is
extensively ruptured. Hysterectomy and extensive resuscitation e orts are performed, but
unfortunately the woman dies. An inquiry is held and the dose of misoprostol used is criticized
for being too high.
What would have been a suitable misoprostol regime to induce labour in this woman?

14)

42 year old second gravida. 39 weeks gestation had prior emergency csection due to fetal
distress 3 years earlier. She is keen to give birth vaginally. Requesting IOL.
what is the most appropriate method minimising risk of uterine rupture.

15)

A 22 year old G1P0 presents to the maternity triage with no fetal movements for 12 hours. An
ultrasound confirms an intrauterine fetal death (IUFD) at 29 weeks gestation.
Which infections should she not be screened for, as they are not associated with IUFD?

16)

.Primi, 30weeks, iufd of one twin, normal CTG for 2nd twin, mother is stable, labs are normal.
Management

17) Induction of labour should not be offered if

18)

A primagravida who is otherwise fit and well, sadly, has a stillbirth at 38 weeks of gestation.
In what proportion of cases is there no identifiable cause?

19)

19 year old lady who had stillbirth at 38 weeks has come to see you 2 weeks after delivery. She
has agreed to have postmortem.
What percentage of still births have congenital anomalies.

20)

A gravida 2 Para 1, booked for low-risk midwifery care presents at 38 weeks with diminished
fetal movements for 48 hours. The fetal heart rate was undetectable and sadly, intrauterine fetal
death was confirmed with an ultrasound scan. The mother would prefer to go home and return
24 hours later for induction after arranging childcare for her other child. Her blood group is B
RhD negative. What would you advise?

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