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RNH > Labour > Flashcards

Labour Flashcards

1
Q

Indications for cardiotocograph

A

Maternal: previous CS, pre-eclampsia, post term pregnancy, induced labour, DM, antepartum haemorrhage, prolonged rupture of membranes

Foetal: FGR, prematurity, oligohydramnios, multiple pregnancy, meconium stained liqour, breech

Note: only time it is not needed is during full term spontaneous uncomplicated labour

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2
Q

Define accelerations and decelerations on CTG

A

accelerations = increase >15bpm above baseline for >15s

decelerations = decrease >15bpm for >15s

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3
Q

Normal vs abnormal contractions

- duration, interval, frequency

A

normal: 3-5/10mins, lasts 60s, interval 60s
abnormal: >5/10min, >2mins duration, <60s interval

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4
Q

Interpreting CTG

A

documentation - name, date, calibration

"DR C BRAVADO"
define risk - reason for CTG
contractions
baseline rate
variability
accelerations
decelerations
overall
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5
Q

Causes of foetal tachycardia and bradycardia

A

Bradycardia

  • maternal - drugs, hypoxia, hypotension
  • foetal - hypoxia, normal for post term

Tachycardia

  • maternal - tachycardia, fever, infection, dehydration, drugs
  • foetal - premature, tachyarrhythmia
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6
Q

Causes for reduced/absent variability

definition of reduced / absent variability

A

sleep
CNS depression - hypoxia, infection, drugs

reduced = 3-5bpm and absent = <3bpm

normal variability = 6-25bpm

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7
Q

Types of decelerations and cause of each

A

early - mirror contraction, small and symmetrical, return to baseline quickly, caused by head compression during contraction (good)

late - just after contraction, no return to baseline for 20s, caused by placental insufficiency

variable - V shaped and large, any time, sharp fall >40bpm, caused by cord compression

prolonged - >2mins

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8
Q

General management of abnormal CTG

A

Call for help - midwife and obstetrician
Reposition mum - left lateral position, encourage to mobilise
Check maternal vitals
IVF
if uterine contractions an issue - stop oxytocin and prostaglandins and consider tocolysis

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9
Q

Define ‘normal birth’

A

37-42 weeks
spontaneous onset vaginal birth
low risk at start of labour and throughout birth
vertex presentation at birth

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10
Q

Define ‘ true labour’

A

regular painful contractions of increasing intensity, duration and frequency

progressive dilation and effacement of cervix

descent of progressing part with progression of station

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11
Q

Define ‘false labour’

A

irregular painless contractions with unchanging intensity and long intervals

no cervical dilation or effacement or descent

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12
Q

What are the stages of labour?

A
  1. 0-10cm cervical dilation
    latent: =3cm, irregular and infrequent contractions
    active: 4-10cm, regular and painful contractions
2. 10cm to delivery of baby 
2h nulliparous
1hr multiparous 
passive/pelvic: no urge
active/perineal: urge to push
  1. delivery of placenta and membranes
    <30mins
  2. 2hrs post partum monitoring of mother and neonate
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13
Q

Foetal movements during delivery

A
  1. descent and engagement
  2. flexion of head
  3. internal rotation so occiput is towards midline near symphysis
  4. extension of head as it is delivered
  5. external rotation / restitution
  6. anterior should delivered
  7. posterior shoulder
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14
Q

Factors affecting course of labour (3Ps)

A

power of uterine contractions

passage - resistance of bony pelvis and soft tissues

passenger - lie, presentation, attitude, position

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15
Q

Types of cephalic presentation

A

vertex - neck flexed, AP diameter is suboccipito-bregmatic

occipitoposterior - baby anterior rather than posterior, head only partially flexed

brow - partial extension, occipitomental (largest diameter)

face - full extension, submento-bregmatic diameter

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16
Q

Engagement definition

A

when bipareital diameter has passed through pelvic inlet

abdominal palpation - 2/5 of head is palpable above symphysis and is fixed

occurs around 36 weeks

17
Q

What is the modified bishop score and what are the components assessed for it

A

pre labour screening of whether induction is required and if cervical ripening is required - predicts likely outcome of IOL

Bishops score
Iffacement 
Station
Hard or soft - consistency 
Opening - dilatation 
Position
18
Q

How to monitor progress of low risk labour

A

VE - on admission and every 4 hours for bishop score
Contractions
Partogram - FHR, cervical dilation, station, contractions, liquor, drugs and fluids, maternal vitals

19
Q

How to monitor foetal condition during labour

A

Intermittent auscultation with hand held doppler - 15 mins in first stage, 5 mins in second
CTG
Foetal scalp and lactate sampling if abnormal FHR or CTG

liquor
moulding - suture lines meet, cross over, cross over but not reducible

20
Q

IVFs during labour - what type and indications

A

Hartmann’s

>6hrs of labour
foetal distress on CTG
foetal or maternal tachycardia
fever 
dehydration
21
Q

Indications for episiotomy

A 
perineum begins to tear 
breech
macrosomia
shoulder dystocia 
instrumental birth
prolonged 2nd stage
22
Q

active management for 3rd stage of labour

A

IV oxytocin shortly after delivery of baby
delayed cord clamping (>2mins) prolong foetal O2 supply
controlled cord traction

23
Q

Non pharm options for pain relief

A

psychoprophylaxis - breathing techniques and coping mechanisms
posture - upright reduces labour time
TENS machine - early stage, 2 electrodes on back
water emersion
heat/cold packs
massage

24
Q

Pharmacological options for pain relief

- benefits and disadvantages

A

paracetamol - early labour

morphine or pethidine - NOT if <2hrs before baby, okay if >4hrs until baby expected

  • effective, easy, fast
  • n&v, constipation, resp depression

nitrous oxide - early labour

  • mother has control, rapid, low SE
  • doesn’t completely relieve pain, confusion

epidural - excellent relief, minimal resp depression, mother has control
- hypotension, headache, prolonged 2nd stage, increased requirement for oxytocin and assisted delivery, reduces mobility, need catheter, neuro risks, infection

25
Q

Degrees of perineal tears

A

1st - vagina and perineal skin
2nd - posterior vaginal wall, underlying perineal muscles, includes episiotomy - requires sutures
3rd - anal sphincter - repair in theatre
4th - anorectal mucosa - repair in theatre and IV Abx

26
Q

indications for IOL

A

maternal - pre-eclampsia, GDM, APH, obstetric cholestasis

foetal - foetal distress, post dates (40+10), SGA/IUGR, macrosomia, infection, Rh disease of newborn

27
Q

risks of IOL

A

failure
cervical ripening - uterine rupture, laceration (balloon), hyperstimulation, bronchospasm, glaucoma
ARM - infection, cord prolapse, abruption
oxytocin - uterine hyperstimulation, rupture, cord prolapse

28
Q

methods for IOL (4)

A

cervical ripening - if MBS <7 and membranes intact; balloon catheter or dinoprostone (prostaglandin) if balloon fails

ARM - MBS >7 with favourable cervix

oxytocin - used after ROM (do not use within 6hrs of dinoprostone gel, can be used 30mins post removal of pessary)

29
Q

Ddx of maternal collapse during labour

A

hypovolemia - septic shock, ruptured aneurysm
hypoxia - dissection, asthma, PE
hypothermia - rare
hyper/hypokalaemia - rare

tension PTX
tamponade
thromboembolism - AF embolism, PE, MI (dissectio)
toxins - MgSO4, insulin, local

30
Q

Cause and mx of uterine inversion

A

over enthusiastic cord traction or placentation densely attached to uterus

relocate manually, if that doesn’t work go to theatre

31
Q

Cord prolapse management

A

do not touch cord - causes spasm

put hand up and push presenting part of foetus up to prevent cord spasm and occlusion

cat 1 CS

32
Q

shoulder dystocia presentation and complications

A

turtle sign - head presents and retracts

complication - hypoxia, Erb’s palsy

33
Q

mx of shoulder dystocia

A

HELPERR

call for Help
consider Episiotomy
Legs on McRoberts manoeuvre (hug to chest)
suprapubic Pressure

above should work, if not:
Enter and manoeuvre baby
Remove posterior arm
Roll patient onto hands and knees and reattempt

34
Q

definition of primary and secondary PPH

A

primary - >500ml vaginal >1000ml CS

secondary - >24 hours up to 6 weeks post partum

35
Q

Causes of PPH

A

uterine atony

  • over distension ie multiparty, multiple pregnancy, polyhydramnios, GDM, macrosomia
  • prolonged labour >12 hours

trauma

  • malpresentation
  • perineal, vaginal, cervical tears

tissue

  • retention of products
  • praaevia or abruption

thrombin

  • PET
  • coagulopathy
  • anticoagulants
  • DIC
36
Q

general Mx of PPH

A

IV access

remove retained products, uterine fundus massage, bimanual compression, uterotonics, TXA, uterine tamponade, uterine compression suture, embolisation, hysterectomy

37
Q

types of uterotonics for PPH

A

IV oxytocin
IV ergometrine
IM carboprost
PR or sublingual misoprostol

RNH (9 decks)

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