Flashcards in 10.2 Deck (24):
What are the three elements of labour that need to be considered when there is failure to progress in labour? Give examples
- Insufficient uterine contraction
- Abnormal bony pelvis, rigid perineum
- Fetus too big, breech position
How can power be assessed?
Uterine contraction can be assessed in terms of frequency, amplitude and duration.
Significance of passenger in labour
Size of passenger
What forms the passage?
Bony pelvis and soft tissues.
What are the diameters of the bony pelvis?
Pelvic inlet 10.5 cm
Pelvic cavity 12 cm
Pelvic outlet 11cm
What are the different ways a fetus can lie?
Flexion - head flexed
Extension - head extended
Breech - feet first
- Frank - legs extended towards head
- Full - cross legged
- Single footling - one foot out
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
How can the physiological state of the fetus be monitored during labour?
The fetal heart rate can be assessed using a fetal scalp electrode.
Options when labour gets stuck
Cesaerian section or operative delivery.
What instruments can be used in operative delivery?
Where is a caesarian section made?
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.
What are the effects of oestrogen on oxytocin receptor production in the myometrium?
What effect does progesterone have on the responsiveness of uterus to oxytocin and prostaglandin release?
Why is progesterone required to avoid spontaneous abortion?
Prevents oxytocin from evoking contraction during pregnancy and Ferguson's reflex.
(Before 24 weeks)
What postural change could occur from oestrogen mediated softening of the ligaments in the pelvis?
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
What fetal landmark is used to assess fetal head position in the birth canal?
Fontanelles - soft membranous gaps between cranial bones
What spinal segments does the epidural block?
Define post partum haemorrhage
> 500ml blood loss after delivery.
Most common cause of post partum haemorrhage?
What is the 'lie' of the fetus?
Relationship to the long axis of the uterus.
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.