Intrapartum and Postpartum Care Flashcards

Question

Problems with the perineum in pregnancy/ postpartum care

Answer 1

-85% women sustain perineal trauma after vaginal delivery -Ice packs (up to 20 mins) -Lidocaine gel/spray -Analgesia -Pelvic floor exercises

Answer 2

-1 in 2 women having sex by 6 weeks -Thread check for coil inserted postpartum -No threads? Refer for ultrasound =Hormonal/ copper coil =Implant =Injection

Answer 3

-Mental and physical health -Feeding and behaviour of the baby -Urinary, bowel and sexual function as incontinence and dyspareunia or anxiety about sexual intercourse are issues that many women will not discuss voluntarily. -Blood pressure, urinalysis (resolution of proteinuria in pre-eclampsia) and a general, breast, abdominal and pelvic/perineal examination is performed to ascertain that the uterus has involuted adequately and that any perineal trauma has healed. -A cervical smear is also taken if it is due and contraception is discussed, if it has not already been initiated. -Adjustment to parenthood and any anxieties

Answer 4

-Spontaneous in onset and at term -With vertex presentation -Without undue prolongation -Natural delivery with minimal aids -Without having any complications affecting health of mother and/or baby

Answer 5

-Engagement and descent (occipital transverse) -Flexion (chin to chest) -Internal rotation to OA (90 degrees to occipital anterior) -Crowning (head visible through vagina without receding in between contractions) -Restitution (head extension to realign head and back) -External rotation (face turned to side) -Delivery of anterior shoulder -Delivery of posterior shoulder

Answer 6

-Nulliparous: delay when 2 hours active -Multiparous: delay 1 hour active Consider assisted delivery of concerns about baby wellbeing/ delay in 2nd stage/ maternal comorbidity

Answer 7

-Gush of blood at vagina -Lengthening of umbilical cord -Globular shaped uterine fundus palpation

Answer 8

-NO -IV opioids -Epidural analgesia

Answer 9

Sudden and profuse blood loss or persistent increased blood loss faintness dizziness or palpitations/ tachycardia

Answer 10

Fever, shivering, Abdominal pain and/or offensive vaginal loss

Answer 11

Headaches within 72 hours of birth with visual disturbance/ nausea/ vomiting

Answer 12

Inflammation of breast= build up of milk= milk duct blockage =Breast pain, thrush -Continue to feed/ express, analgesia, fluid intake, exclude abscess

Answer 13

-Reduce hypoxic ischaemic encephalopathy and cerebral palsy -Reduce perinatal death -Reduce unnecessary intervention

Answer 14

-CTG machine (cardio topography, continuous): high risk -Hand held sonic device (intermittent auscultation): low risk

Answer 15

DR C BRAVADO =Dr – determine risk =C - contractions =Bra – baseline rate =V - variability =A - accelerations =D - decelerations Overall plan with clinical assessment: indication to expedite birth?

Answer 16

-Top line= fetal HR (abdominal transducer/ fetal scalp electrode) -Bottom line= toco monitor, change in pressure from around abdomen, frequency and duration of uterine activity (no strength or pressure of contraction): peaks -Space between columns= 10 mins

Answer 17

-Medical conditions: BP, proteinuria, diabetes -Previous caesarean section -Obesity >35 -Significant abdominal pain that is not uterine activity -Post term pregnancy (>42 weeks): induction or augmentation -Prolonged rupture of membranes >24 hours -Maternal tachycardia >120bpm on 2 occasions, 30mins apart -Delay in first or second stage of labour- epidural for analgesia -Antepartum haemorrhage -Maternal pyrexia >38

Answer 18

-Small baby abnormal liquor or doppler -Multiple pregnancy -Prematurity (<37 weeks) -Breech or other malpresentation -Intrauterine infection -Oligohydramnios -Meconium: stained liqor dark green black, thick -Abnormal umbilical artery doppler -History of reduced fetal movements in last 24hours

Answer 19

-Normal variability 5-25bpm, normal 110-160bpm but 150-160bpm in baby at term could be sign of hypoxic stress or infection (pre term babies usually have higher HR) =Tachycardia >160bpm >10 min, term babies may have low baseline -Fewer than 5 contractions -Rise in baseline 20bpm is not normal =Reassuring normal: CTG in which all 3 features are reassuring =Non reassuring suspicious: 1 non-reassuring and 2 reassuring =Abnormal: 1 abnormal feature or 2 non-reassuring

Answer 20

-Chronic -Gradually evolving -Subacute -Rapidly evolving -Acute

Answer 21

-Hypoxic environment: arterial oxygen saturation 70% at start of labour, 30% in uterine contractions -Placenta= respiratory organ: 18-22g fetal haemoglobin to increase oxygen carrying and accessing capabilities -Fetal haemoglobin acts as buffering system to prevent neurological damage in metabolic acidosis -Circulation system: ductus arteriosus (diverts blood from pulmonary artery to ascending aorta), foramen ovale- shunt oxygenated blood from umbilical vein to heart and brain -Beats faster than adult: rapidly distribute blood to organs -HR drops as approaching term gestation (140-145bpm): 150+ at term sign of hypoxia stress infection

Answer 22

-Chorionic plate (fetal side of placenta) covered in blood vessels that originate from umbilical vein arteries in umbilical cord =Arterial vessels on chorionic plate dive down into main body, progress to smaller fetal capillaries bathed in maternal blood -Maternal side implanted into myometrium, tiny spiral vessels form gas exchange- oxygen and nutrients into placental unit, waste products out to maternal circulation =Hypertension impairs development: impaired vascular endothelial function= suboptimal gas exchange and less formation of blood vessels =Diabetes: fewer pools of maternal blood, fewer places for effective gas exchange

Answer 23

-Hallmark of fetal neurological responsiveness and absence of hypoxia/ acidosis= alteration of different behavioural states -Fetal quiescence (deep sleep, lasts up to 50 mins, stable baseline, rare accelerations, borderline variability) =Active sleep (REM sleep, most frequent state, moderate accelerations, normal variability) =Wakefulness (rarer, large number of accelerations can lead to confluence and difficult baseline interpretation, normal variability) -Transitions between the different patterns become clearer after 32-34 weeks of gestation

Answer 24

-Decelerations= transient times to greater hypoxic stress (contractions) to protect myocardium (stop full capacity) -Stops moving (conserve non essential activity)= loss of accelerations (insufficient oxygenation to vital organs)

Answer 25

-Continuing hypoxia causes decompensation in the central nervous system (inadequate oxygen reaching the fetal brain) -If the hypoxia continues, stress hormones (catecholamines) are released from fetal adrenal gland (adrenaline and noradrenaline) which increases the HR (tachycardia) to increase oxygenation. =This requires energy- glycogen is broken down to glucose which also maintains positive energy balance in the heart (further protection) -Loss of baseline variability and ultimately myocardial hypoxia- unstable baseline and progressive reduction in Fetal HR (bradycardia)

Answer 26

-Release of adrenaline stimulate glycogenolysis -When fetal oxygen supply is no longer sufficient to maintain energy requirements, glucose is released from glycogen stores and metabolised anaerobically (without oxygen) -During anaerobic metabolism, stores of glycogen in the heart, muscle and liver are broken down to provide energy -Lactate is the by-product of anaerobic metabolism, which eventually causes the pH of the fetal blood to fall further (metabolic acidosis) =Leads to HIE (Hypoxic ischaemic encephalopathy)

Answer 27

-Significantly reduced variability with without raised baseline and shallow decelerations -Develops over weeks or days =Expedite delivery ASAP so urgent birth (will not have the reserve to cope with labour) -Features: Baseline rate of the upper end of normal, reduced variability and absence of cycling, usually shallow chemoreceptor decelerations -Physiology: catecholamine release, vasoconstriction- fetal CNS compromise, acidosis secondary to placental insufficiency -Escalation: if classified as abnormal antenatal CTG, likely needs delivery- should be discussed with LW coordinator, ST67 or consultant obstetrician

Answer 28

-Cause hypoxic state: during contraction, gas exchange in placental unit impaired= retention of CO2 and lowering of fetal pH -Intercontraction interval= gas exchange occurs again= reperfusion baby -Normal frequency, strength, duration, and the resting tone =Less than or equal to 4 in 10 mins with good resting tone; important to palpate manually to assess strength. =If frequency of contractions cannot be assessed reliably by the tocodynamometer, manual palpation for 10 minutes every 30 minutes is required -Tachysystole- contractions >5 in 10 mins (inadequate gas exchange= fetal compromise and abnormal HR) -Hypertonus – contraction lasting more than 2 mins -Hyperstimulation – iatrogenic (prostaglandin oxytocin) or physiological contractions >5 in 10 or hypertonus leading to CTG abnormalities OR Contractions of normal duration occurring within 60 seconds of each other. -Lack of baseline resting tone

Answer 29

-Accelerations: transient increase above baseline by 15bpm for 15 seconds. 2+ in 20 mins (reassuring), absence is less certain (normal in deep sleep, chronic or evolving hypoxia) =Erroneous monitoring of maternal pulse show accelerations of greater magnitude often in contractions (second stage especially) =Fetus raise HR also in contractions =Maternal/fetal HR monitored?

Answer 30

-Early – coincide with contractions – typically late first stage and early second stage; Do not indicate hypoxia: (Parasympathetic)- short lasting and return quickly to baseline (reflex neurological response) -Variable – variable in shape, timing + duration. Occur due to cord compression due to baro-receptor and/or peripheral chemoreceptor stimulation -Late – typically start 20 secs after peak contraction and recover after the contraction ends (longer and later recovery to baseline) indicative of a chemoreceptor-mediated response to fetal hypoxaemia -Chemical induced: suggest decompensation (take much longer to recover, loss of accelerations, reduction in variability), loss of shouldering, drop below 60bpm, delay in return to baseline, overshoot present =Give terbutaline early: if no improvement expedite delivery

Answer 31

-Hypoxia begins with decelerations -Accelerations disappear (reduce non essential activity) -Baseline HR: increases (catecholamines) -Compensated stress (stable baseline HR and normal variability but deep wide decelerations) -Decompensation (unstable baseline and changes in variability: reduced variability or significantly increased above 25bpm) -End stage: myocardial failure with step ladder to death

Intrapartum and Postpartum Care Flashcards

(55 cards)