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Flashcards in 10.2 Deck (24):
1

What are the three elements of labour that need to be considered when there is failure to progress in labour? Give examples

Power
- Insufficient uterine contraction
Passage
- Abnormal bony pelvis, rigid perineum
Passenger
- Fetus too big, breech position

2

How can power be assessed?

Uterine contraction can be assessed in terms of frequency, amplitude and duration.

3

Significance of passenger in labour

Size of passenger
Number
Position

4

What forms the passage?

Bony pelvis and soft tissues.

5

What are the diameters of the bony pelvis?

Pelvic inlet 10.5 cm
Pelvic cavity 12 cm
Pelvic outlet 11cm

6

What are the different ways a fetus can lie?

Transverse lie

Longitudinal lie:
Flexion - head flexed
Extension - head extended
Breech - feet first
- Frank - legs extended towards head
- Full - cross legged
- Single footling - one foot out

7

What is the most common position in which a baby lies?

Longitudinally, in a cephalic presentation, well flexed so vertex present to pelvic inlet.
Diameter = 9.5cm

8

How can the physiological state of the fetus be monitored during labour?

The fetal heart rate can be assessed using a fetal scalp electrode.

9

Options when labour gets stuck

Cesaerian section or operative delivery.

10

What instruments can be used in operative delivery?

Forceps
Vaccuum extraction

11

Where is a caesarian section made?

Suprapubic/hypogastric incision

12

Describe a C section cut.

Linea alba and anterior layers of rectus sheath are transected and resected superiorly.
Rectus muscles are retracted laterally or divided through their tendinous parts allowing attachment without muscle fibre injury.

13

What are the effects of oestrogen on oxytocin receptor production in the myometrium?

Increases.

14

What effect does progesterone have on the responsiveness of uterus to oxytocin and prostaglandin release?

Reduces effect.

15

Why is progesterone required to avoid spontaneous abortion?

Prevents oxytocin from evoking contraction during pregnancy and Ferguson's reflex.
(Before 24 weeks)

16

What postural change could occur from oestrogen mediated softening of the ligaments in the pelvis?

Lordosis

17

What anatomical landmark gives an estimate for 12 weeks and 20 weeks of gestation? 36 weeks?

12 - uterus palpable
20 - Mother's umbilicus
36 - Xiphisternum

18

What fetal landmark is used to assess fetal head position in the birth canal?

Fontanelles - soft membranous gaps between cranial bones

19

What spinal segments does the epidural block?

T9-S4

20

Define post partum haemorrhage

> 500ml blood loss after delivery.

21

Most common cause of post partum haemorrhage?

Uterine atony

22

What is the 'lie' of the fetus?

Relationship to the long axis of the uterus.

23

What is the 'presentation' of the fetus? What is breech position?

Which part is adjacent to the pelvic inlet:
Normal head down = cephalic
Sometimes buttocks = podalic
Breech positions are any abnormal presentations.

24

What is the vertex of the fetus?

Relationship of fetus along its axis.
Vertex to pelvic inlet at minimum diameter.