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O&G > Labour and Delivery 1 > Flashcards

Labour and Delivery 1 Flashcards

1
Q

What is the definition of labour?

A

painful uterine contractions accompanying dilation and effacement of cervix
process whereby fetus and placenta are expelled from the uterus, usually between 37 and 42 weeks

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2
Q

What is the first stage of labour?

Dilation period

A

initiation (when regular contractions start) to full cervical dilation

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3
Q

What is the second stage of labour?

A

full cervical to delivery of the fetus

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4
Q

What is the third stage of labour?

A

delivery of the fetus to delivery of the placenta

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5
Q

What is effacement?

A

Bulb shape of cervix flattens when contractions staring and full dilation of the cervix

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6
Q

What is the normal rate of dilation?

A

1-3cm per hour

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7
Q

How are patients monitored during labour?

A

vaginal exam every 4 hours - assess dilation and position of the head (distance from ischial spine)

maternal urine every 4 hours - if ketones give 10% dextrose IV

maternal BP and temp every 1/2 hour

Contractions every 15 mons

Fetal HR every 15 mins

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8
Q

What are the key components of an abdominal palpation?

A 
Lie - longitudinal, transverse
Attitude - posture, flexed, extended 
Presentation - cephalic/breech
Position - left OA
Engaging diameter 
Denominator = presenting part
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9
Q

What will occur in stage 2?

A

complete dilation - 10cm

mother will feel the urge to push using abdo muscles and Valsalva

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10
Q

What is the normal duration of stage 2 if a primip and a multip?

A

45-120 mins in a primip

15-45 mins in a multip

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11
Q

What is engagement?

A

largest part of the fetal head entering the pelvis

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12
Q

What is restitution?

A

head turning to face postero-laterally

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13
Q

What is external rotation?

A

shoulders turning for delivery

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14
Q

Describe stage 3

A

delivery of the placenta and membranes
bleeding control
uterus shrinks after delivery
placenta separates from the uterine wall

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15
Q

When is syntometrine given?

A

after head and anterior should delivered (otherwise risk of shoulder dystocia) to reduce the length of stage and risk of PPH

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16
Q

What is a post partum haemorrhage?

A

loss of >500mls blood after delivery

17
Q

What are the causes of PPH?

A

trauma
tissue - placental retention
thrombin - coagulation disorders
tone - uterine atony (80% of PPH)

18
Q

What are the RFs for PPH?

A

polyhydramnios
multiple gestations
prolonged labour
excess oxytocin

19
Q

What are the two most important RFs to consider for DVT prophylaxis?

A

age >35

BMI >35 or weight over 90kg

20
Q

What are the other RFs considered for DVT prophylaxis?

A 
parity >4 
varicose veins 
nephrotic syndrome 
sickle cell
IBD
pre-eclampsia 
infection 
labour >12 hours
excess blood loss
dehydration 
immobility 
forceps delivery
21
Q

What are some examples of delivery complications?

A 
arrest of descent 
nuchal cord ]
fetal distress
perineal lacerations 
shoulder dystocia
22
Q

What is an episiotomy?

A

a cut in the perineum

23
Q

What are the indications for an episiotomy?

A 
perineal tear appears inevitable 
fetal distress
pre-term delivery 
breech delivery 
forceps or ventouse delivery
24
Q

What are the pros of an episiotomy?

A

easier to repair

decreased trauma to perineum

25
Q

What are the side effects of an episiotomy?

A

pain
blood loss
breakdown of wound
dyspareunia - pain during intercourse

26
Q

What is a 1st degree perineal laceration?

A

vaginal mucosa and perianal skin

27
Q

What is a 2nd degree perineal laceration?

A

perianal muscles

28
Q

What is a 3rd degree perineal laceration?

A

external anal sphincter

29
Q

What is a 4th degree perineal laceration?

A

anterior rectal wall is involved

30
Q

How common is shoulder dystocia?

A

0.2-2% of deliveries

40-50% in low birth weight

31
Q

What are the RFs for shoulder dystocia?

A

fetal macrosomia
diabetes
prolonged second stage

32
Q

What are the risks of shoulder dystocia?

A

maternal morbidity - PPH, 4th degree lacerations

neonatal morbidity - asphyxia, brachial plexus erb palsy, humerus or clavicle fracture

O&G (25 decks)

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