What is Syntocinon
A synthetic oxytocin
It is an octapeptide that causes rhythmical uterine contractions
What does Ergometrine do?
It causes prolonged spasm (tetanic contraction) of the uterus
What is the most common cause of dehydration in pregnancy?
- Vomiting, especially hyperemesis gravidarum
- It can also cause Wernicke's encephalopathy, due to depletion of thiamine.
Oedema of the scalp due to pressure of the head against the rim of the cervix.
What structure is station of the foetal head measured against?
The ischial spines of the mother
What happens to the foetal head when it hits the pelvic floor?
It rotates from the LOL to the Occipito-Anterior position
The head is then delivered by extension of the neck.
How can the station be determined?
Only by vaginal examination
Name the 2 cardinal signs of labour.
- Effacement of the cervix
- Dilation of cervix.
Name 2 physiological causes of anaemia in pregnancy.
- 50% increase in plasma volume, dilutes Hb, haemocrit and RC count
- Iron requirement increases 2-3 x and folate needs increase by 10-20 x.
What Risk Screening can be done for Downs Syndrome?
Triple test at 15-20 weeks ( only test NHS uses). Checks hormone levels of alpha fata protein and maternal age. +ve screen gives 1/150 risk of downs
Nuchal Transluscency at 11-14 weeks. Increased NT suggests foetal heart failure, stongly associated with chromosomal abnormalities. Integrated test
Which part of the cervix is related to when "dilatation of the cervix" is mentioned?
The external os
What is the normal attitude of the foetus?
Full flexion when normal presentation is vertex.
How long do the effects of Ergometrine last?
They persist for 30 minutes
What stage of labour is Syntometrine given?
Given in the 3rd stage, as the anterior shoulder appears under the pubic symphysis.
How large is the Occipito-Frontal diameter?
When does this present?
When the foetal head is in the Occipito-Posterior position.
At what station can instrumental delivery occur below?
What should be given to women with multiple risk factors for VTE?
Low Molecular Weight Heparin (LMWH)
What are the risk factors of having a child with Downs Syndrome?
- Maternal age
- Family History
What are the 3 main features of labour?
- Regular painful uterine contraction
- Dilatation of the cervix
- Descent of the foetal head.
How long does Syntocinon take to work when given IM?
2 minutes if given IM.
What is restitution?
The foetal head turns 45 degrees to restore its normal relationship with the shoulders, which are still at an angle.
What is Syntometrine?
10iu of Syntocinon and 500 μm of Ergometrine
What are the 8 positions of the feotal head
- Occiput Posterior
- Occiput Anterior
- Left Occiput Anterior (LOA)
- Right Occiput Anterior (ROA)
- Left Occiput Lateral (LOL)
- Right Occiput Lateral (ROL)
- Left Occiput Posterior (LOP)
- Right Occiput Posterior (ROP).
Name the 2 main types of presentation
- Cephalic; either vertex, face or brow
What is effacement?
The incorporation of the cervical canal into the lower uterine segment from the internal os downwards.
What are the signs and symptoms of Downs Syndrome?
- Brachycephaly - flat head syndrome
- Low set ears
- Protruding tongue
- Flat nasal bridge
- Hypotonia - low muscle tone
- Small hands with single palmar crease
How is the baby scored upon birth?
Through the Apgar Scoring System
Descent of biparietal diameter through pelvic brim. If head is at the level of the ischial spines it must be engaged unless there is caput. When head is engaged no more than 2/5ths can be felt abdominally.Engagment usually occurs after labour is established.
What is the normal lie of the foetus?
The relationship of the presenting part of the foetus to the mother's pelvis.
What happens to the shoulders after restitution?
They rotate into the anterio-posterior diameter of the pelvis, and the anterior shoulder slips under the pubis and
With lateral flexion the baby is born.
Relation of the long axis of the foetus to the mother's. It may be longitudinal, oblique or transverse.
Arbitrary part of presentation:
- Occiput in vertex
- Sacrum in breech
- Mentum in face presentation
It denotes position of presenting part with reference to the pelvis.
What should you do if a woman presents with placenta praevia?
- Monitor and admit if she is bleeding
- CS delivery
What is the risk of having a thromboembolism in pregnancy compared to a non-pregnant woman?
10 times, prothrombic state from early gestation
What is displayed on a partogram?
- Feotal HR
- Cervix dilation (cm)
- How many contractions per 10 minutes.
Name 4 characteristics of a Primigravid labour.
- Unique psychological experience
- Inefficient uterine action -> prolonged labour if untreated
- Rupture of uterus virtually unknown
- Risk of cephalopelvic disproportion and foetal trauma.
Part of the foetus in the lower pole of the uterus.
What are the diagnostic tests for Downs Syndrome
- Amniocentesis - 12-18 weeks; amniotic fluid sample containing foetal cells. 99% accuracy.
- Chronic Villus Sampling - 11-13 weeks; placental Biopsy taken and karyotyped. 97% accuracy.
What are the side effects of Ergometrine?
Contra-indicated in hypertension and cardiac disease.
How long does Ergometrine take to work if given IV and how is that different if given IM?
40 seconds if given IV
6 minutes if given IM.
What movement of the neck occurs after the head descends past the pelvic brim?
What is the presenting diameter known as?
- The neck flexes
- Presenting diameter known as Suboccipito-Bregmatic
What is another name for Controlled Cord Traction (CCT)?
What chromosomal abnormality gives rise to Downs syndrome?
Trisomy 21 (inheritance of three chromosome 21s)
What is the range that is is classified as "term"
37 - 42 Weeks
What is the "show"?
The show, or operculum, is a blood stained mucous discharge which approximately 2/3 of women give a history of having by the onset of labour.
How many women report spontaneous rupture of membrane (SRM)
What are Ergometrine's beneficial effects after the birth?
It can help control post-partum haemorrhage
What the effects of pre-eclampsia?
- Deranged renal/ hepatic function
- CNS/PNS effects when acute - eclampsia or stroke
What are the associated conditions with Downs syndrome?
Cardiology defects: Atrial/Ventricular spetal defects,Patent ductus arteriosis (blood flow between aorta and pulmonary artery, 7%)
GI defects: Oesphageal atresia, Duodenal atresia, pyloric stenosis
- Low IQ
How large is the Occipito-Bregmatic diameter?
When does Down's syndrome usually present?
Presented antinatally as a result of screening e.g. Amniocentesis at 16-22 weeks
Describe the 3rd stage of labour.
- The cord lengthens
- Gush of blood
- Fundus of uterus rises.
What are the risk factors for a Venous Thromboembolism (VTE) in pregnancy?
- Hisotory of VTE, including a family history
- Gross varicosities
- Dehydration or immobility
- Surgery during pregnancy or puerperium
How many stages of labour are there, and what happens at each?
- 1st stage - Onset of labour to full dilatation of cervix (10cm); either latent or active
- 2nd stage - Full dilatation to delivery of baby; propulsive or expulsive
- 3rd stage - Delivery of baby to expulsion of placenta & membranes.
Name 3 characteristics of a multigravid labour
- Uterine action efficient - dystocia rare
- Risk of uterine rupture
- Disproportion and trauma rare if mother has had previous vaginal surgery.
What is pre-eclampsia?
- ± oedema
What notation are the ischial spines referred to, in regards to the station of the foetus?
Overlapping of the vault bones - the shape of the skull alters so engaging diameters become shorter
What is abruption?
It is where the placenta separates from the uterine wall of the mother.It may be concealed, chronic revealed or acute.
It can lead to foetal death, maternal hypovolaemic shock and coagulopathy.
Posture of the foetal head, such as flexion, deflexion or extension
What position is the foetal head at the beginning of labour?(At the pelvic brim)
Left-Occiputo Lateral (LOL)
What are the causes of bleeding in pregnancy?