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Obstetrics > Labour > Flashcards

Labour Flashcards

1
Q

What is failure to progress?

A

Labour not developing at a satisfactory rate

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2
Q

Ps of progress in labour

A

Power: uterine contractions

Passenger: size, presentation and position of the baby

Passage: the shape and size of the pelvis and soft tissues

Psyche

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3
Q

Phases of first stage of labour

A

Latent
Active
Transitional

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4
Q

Latent phase

A

0-3cm dilation of cervix
0.5cm/hr
irregular contractions

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5
Q

Active phase

A

3-7cm dilation of cervix
1cm/hr
Regular contractions

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6
Q

Transitional phase

A

7cm-10cm dilation of cervix
1cm/hr progression
strong and regular contractions

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7
Q

Delay in labour:
First stage
Second stage
Third stage

A

1st stage:
Less than 2cm of cervical dilatation in 4 hours
Slowing of progress in a multiparous women

2nd stage:
Pushing more than 2 hours in nulliparous
Pushing more than 1 hour in multiparous

3rd stage:
>30 mins active management
> 60 mins physiological management

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8
Q

Passenger

A

Size: shoulder dystocia
Attitude: posture
Lie: position of fetus in relation to mother’s body
Presentation: part of fetus closest to cervix

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9
Q

Risk factors for uterine rupture in VBAC

A 
Previous c section
Previous uterine surgery 
Obstruction or induction of labour
Multiparity
Multiple pregnancies
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10
Q

Absolute contraindications to VBAC

A

Classical c section scar
Previous uterine scar
Contraindications to vaginal birth

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11
Q

Active management of the third stage of labour

A

im oxytocin

controlled cord traction

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12
Q

management of failure to progress

A

amniotomy: ARM
oxytocin infusion
instrumental delivery
c section

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13
Q

Relative contraindications to VBAC

A

Complex uterine scars

>2 prior lower segment c sections

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14
Q

Management of VBAC delivery

A

These women should deliver in a hospital setting with facilities for emergency caesarean and advanced neonatal resuscitation.

There should be continuous CTG monitoring.

Beware of additional analgesic requirements during the labour as may indicate impeding uterine rupture.

Avoid induction where possible.

If induction is required, the risk of uterine rupture is less using mechanical techniques (e.g. amniotomy) than induction with prostaglandins.

Be cautious with augmentation (increased risk of uterine scar rupture)

Any decisions about both induction and augmentation require input from a senior obstetrician.

After 39 weeks an elective repeat caesarean is recommended delivery method.

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15
Q

when does normal labour and delivery usually occur?

A

37-42weeks

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16
Q

definition of labour

A

progressive dilatation and effacement of cervix in presence of regular uterine contractions

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17
Q

delivery definition

A

expulsion of feotus and placenta

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18
Q

show defintiino

A

cervical mucus plus

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19
Q

gravidity

A

total number of pregnancuies

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20
Q

parity

A

the state of having given birth
>24 weeks
>500g

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21
Q

three stages of labour

A

First stage – from the onset of labour (true contractions) until 10cm cervical dilatation

Second stage – from 10cm cervical dilatation until delivery of the baby

Third stage – from delivery of the baby until delivery of the placenta

22
Q

braxton-hicks contractions

A

Braxton-Hicks contractions are occasional irregular contractions of the uterus. They are usually felt during the second and third trimester. Women can experience temporary and irregular tightening or mild cramping in the abdomen. These are not true contractions, and they do not indicate the onset of labour. They do not progress or become regular. Staying hydrated and relaxing can help reduce Braxton-Hicks contractions.

23
Q

signs of labour

A

Show (mucus plug from the cervix)

Rupture of membranes

Regular, painful contractions

Dilating cervix on examination

24
Q

indications for continuous CTG monitoring in labour

A

Sepsis

Maternal tachycardia (> 120)

Significant meconium

Pre-eclampsia (particularly blood pressure > 160 / 110)

Fresh antepartum haemorrhage

Delay in labour

Use of oxytocin

Disproportionate maternal pain

25
Q

CTG features to look for

A

Dr C BRAVADO

Contractions – the number of uterine contractions per 10 minutes

Baseline rate – the baseline fetal heart rate

Variability – how the fetal heart rate varies up and down around the baseline

Accelerations – periods where the fetal heart rate spikes

Decelerations – periods where the fetal heart rate drops

Overall impression

26
Q

Contractions on CTG

A

Number of contractions present in 10 squares

Duration and intensity

27
Q

Too many contractions

A

uterine hyperstimulation, fetal compromise

28
Q

too few contractions

A

labour not progressing

29
Q

fetal tachycardia causes

A 
>160
fetal hypoxia
chorioamnionitis
hyperthyroidism
fetal/ maternal anaemia
fetal tachyarrhythmia
30
Q

fetal bradycardia causes

100-200

A

postdate gestation

occiput posterior or transverse presentations

31
Q

causes of prolonged, severe bradycardia in ctg

A 
prolonged cord compression
cord prolapse
epidural and spinal anaesthesia
maternal seizures
rapid fetal descent
32
Q

normal variability CTG

A

5-25

33
Q

causes of reduced variability

A 
fetal sleeping 
fetal acidosis 
fetal tachycardia
drugs: opiates, benzodiazepines
prematurity
congenital heart abnormalities
34
Q

early decelerations

A

start when uterine contraction begins and recover when uterine contraction stops
normal

35
Q

causes of early decelerations

A

uterus compressing the head of the fetus
stimulating vagus nerve
slowing heart rate

36
Q

late decelerations causes

A

maternal hypotension
pre-eclampsia
uterine hyperstimulation

37
Q

variable decelerations causes

A

umbilical cord compression

if shoulders are there not worrying

38
Q

fetal bradycardia rule of 3s

A

3 minutes – call for help

6 minutes – move to theatre

9 minutes – prepare for delivery

12 minutes – deliver the baby (by 15 minutes)

39
Q

sinusoidal CTG causes

A

severe fetal hypoxia
severe fetal anaemia
fetal/maternal haemorrhage

40
Q

oxytocin indication

syntocinon

A

induction of labour
progressiob of labour
increase strength of contracetions
PPH

41
Q

atosiban indication

A

oxytocin receptor antagonist

alternative to nifedipine in premature labour

42
Q

ergometrine indication

A

PPH

third stage of labour

43
Q

prostaglandins indication

dinoprostone

A

induction of labour

44
Q

misoprostol

A

prostaglandin analogues

medical management of miscarriage

45
Q

mifepristone

A

anti-progestogen
blocks progesterone and ehnances prostaglandins
used in induction of labour after intrauterine fetal death and alongside misoprostol for abortions

46
Q

nifedipine

A

CCB that acts to reduce smooth muscle contraction in blood vessels and uterus
reduces BP
tocolysis in premature labour, delay onset

47
Q

terbulatline

A

B2 agonist

tocolysis in premature labour

48
Q

carboprost

A

prostaglandin analogue
stimulates uterine contraction
PPH
caution in asthma

49
Q

Gas and Air (Entonox)

A

Gas and air contains a mixture of 50% nitrous oxide and 50% oxygen. This is used during contractions for short term pain relief.

50
Q

Intramuscular Pethidine or Diamorphine

A

IM opioid
They may cause drowsiness or nausea in the mother, and can cause respiratory depression in the neonate if given too close to birth. The effect on the baby may make the first feed more difficult.

51
Q

PCA

A

remifentanil

52
Q

epidural side effects

A

Headache after insertion

Hypotension

Motor weakness in the legs

Nerve damage

Prolonged second stage

Increased probability of instrumental delivery

Obstetrics (10 decks)

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