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Labour Flashcards

1
Q

What is the fetal lie

A

The relationship of longitudinal axis to fetus along axis of the mother

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2
Q

Examples of fetal lie

A

Vertex, breech, transverse

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3
Q

What is fetal presentation

A

Part of the fetus which leads the way out through the birth canal first - the presentating part

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4
Q

Examples of fetal presentation

A

Cephalic is ideal, but there can be different breech presentations

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5
Q

How is the position of the fetus described

A

Whether the fetus is facing forwards (facing up) or rearwards (towards back of mother).
What the denominator is (cephalic - occiput, breech - sacrum or face - mental)

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6
Q

How is the station of the fetus described

A

Relationship of the presenting part to the ischial spines - measured in cm above or below the ischial spines and assessed vaginally

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7
Q

How is the attitude of the fetus described

A

Relationship of the fetus’ body parts to one another - normal is when the head is tucked in to the chest with its arms

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8
Q

Types of breech presentation

A

Complete, incomplete, extended and footling breech

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9
Q

What is a complete breech presentation

A

Legs are fully flexed at the hips and knees

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10
Q

What is an incomplete breech presentation

A

With one leg flexed at the hip and extended at the knee

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11
Q

What is an extended breech presentation

A

Frank breech, with both legs flexed at the hip and extended at the knee

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12
Q

What is a footling breech

A

Foot is presenting through the cervix with one leg extended

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13
Q

What happens to breech babies before 36 weeks

A

They often turn spontaneously so no intervention is needed, but ECV can be used at 37 weeks

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14
Q

What is the process of ECV

A

External cephalic version which is 50% successful - tocolysis is used to relax uterus before procedure and it with subcutaneous terbutaline

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15
Q

What units are used to assess uterine activity in labour

A

Montevideo units - quantifying assessment where the peak strength of contractions in mmHg measured by internal monitor multiplied by frequency in 10 minutes

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16
Q

How is uterine activity assessed in labour

A

Palpation manually.
Internal uterine pressure catheters inserted.
Electro hysterography (less freq used)
Tocodynamometry measured through abdomen

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17
Q

What are the 7 cardinal movements of labour

A

Engagement difference
Flexion of head
Internal rotation
Extension
Restitution to
External rotation
Delivery of baby

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18
Q

What are the three stages of labour

A
  1. Cervical dilatation - latent and active phase
  2. Delivery of baby - descent of head and pushing
  3. Delivery of placenta
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19
Q

How much dilatation occurs in the first latent stage of labour

A

0-4cm

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20
Q

How much dilatation occurs in the first active phase of labour

A

4-7cm

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21
Q

How long is the first stage of labour

A

8-12 hours

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22
Q

What happens in the first stage of labour

A

Cervix relaxes, becocming thinner and dilating, contractions increase in intensity

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23
Q

What happens in the second stage of labour

A

Contractions increase further in strength and cervix is fully dilated, the mother pushes and baby is delivered

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24
Q

How long does the second stage of labour last

A

20 minutes - 2 hours

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25
What happens in the third stage of labour
Gentle pushing and expulsion of the placenta
26
How long is the third stage of labour
5 - 30 minutes
27
How much dilatation occurs in the transition phase of labour
7-10cm
28
What happens to the mucus plug in first stage of labour
'Show' = where is falls out and creates space for the baby to pass through
29
How is the onset of labour diagnosed
Show, rupture of membranes, regular painful contractions and dilating cervix
30
What are Braxton -Hicks contractions
Occasional irregular contractions of the uterus which are felt duing the second and third trimester
31
Symptoms of Braxton-Hicks contractions
Tightening and mild cramping Temporary Not true contractions Do not indicate onset of labour Do not progress of become regular
32
When is induction of labour indicated
41-42 weeks gestation Prelabour ROM IUGR Pre-eclampsia Obstetric cholestasis Existing diabetes IUFD
33
What is the Bishop Score
Used to determine whether to induce labour
34
What are the options for inducing labour
Membrane sweep Vaginal prostaglandin E2 Cervical ripening balloon Artificial ROM Oral mifepristone plus misoprostol
35
What does a membrane sweep involve
Inserting finger into cervix to stimulate it and begin process. Produces onset of labour within 48 hours
36
when is membrane sweep used
More of an assistance before full induction, used from 40 weeks gestation to attempt to initiate labour in women over EDD
37
What does vaginal prostaglandin E2 involve
Dinoprostone given as gel, tablet or pessary into vagina which stimulates cervix and uterus to cause onset of labour - releases prostaglandin over 24 hours
38
What does a cervical ripening balloon involve
Silicone balloon which is inserted into cervic and infalted to gently dilate cervix
39
When is cervical balloon ripening indicated
As alternate to prostaglandin, usually in women with previous caesarean, when prostaglandins have failed or multiparous women
40
What does artificial ROM involve
Oxytocin infusion
41
When is artificial ROM used
Reasons not to use prostaglandins or after the use of them
42
When are mifepristone and misoprostol used
Induce labour when IUFD has occured
43
What does Bishop score include
Cervical position Cervical consistency Effacement Dilation Baby's station
44
Monitoring during labour induction
CTG and bishop score
45
What management options are there is there is slow or no progress of labour
Further vaginal prostaglandins Artificial rupture of membranes CRB Elective Caesarean
46
What is uterine hyperstimulation
Main complication of induction of labour with vaginal prostaglandins where the contractions of the uterus are prolonged and frequent, causing fetal distress and compromsie
47
What is the criteria for uterine hyperstimulation
Individual uterine contractions lasting more than 2 minutes in duration. More than 5 uterine contractions every 10 minutes
48
What are the complications of uterine hyperstimulation
Fetal compromsie, emergency caesarean, uterine rupture
49
What is cardiotocography
Used to measure the fetus heart rate and contractionso f the uterus
50
What can sinusoidal CTG indicate
Severe fetal anaemia - often caused by vasa praevia
51
What does engagement mean
Largest diameter of fetal head descends into the maternal pelvis - referring to widest part of the fetal head successfully negotiating its way down into maternal pelvis
52
Two options for prophylaxis of preterm labour
Vaginal progesterone and Cervical cerclage
53
What is the role of vaginal progesterone in preterm labour
Maintains pregnancy and prevents labour by decreasing activity of myometrium and stopping cervix remodelling in preparation for delivery.
54
When is vaginal progesterone offered
Women with cervical length less than 25mm on vaginal USS between 16-24 weeks gestation
55
How is vaginal progesterone given
As a gel or pessary
56
What is cervical cerclage
Where a stitch is put into the cervix to add support and keep it closed - involves spinal or GA and stitch is removed when woman goes into labour or reaches term.
57
Indication for cervical cerclage
Cervical length less than 25mm between 16-24 weeks gestation, who have had previous prem birth or trauma
58
What is tocolysis used for
Nifedipine is a CCB which suppresses labour and blocks contractions. Used as a short term measure between 24-34 weeks
59
What are maternal corticosteroids used for
Offered from 35 weeks gestation to reduce neonatal morbidity and reduce RDS. Used in women with suspected preterm labour of less than 36 weeks.
60
What drugs and dose are used for maternal corticosteroids
Two doses of betamethasone 24 hours apart for example
61
What is IV magnesium sulphate used for
Given before 34 weeks gestation and helps protect baby's brain - given within 24 hours of delivery of preterm babies of less than 34 weeks gestation.
62
How is IV magnesium sulfate given and monitoried
Bolus followed by infusion of up to 24 hours and close monitoring every 4 hours due to toxicity
63
What is delayed cord clamping / cord milking
Increases circulating blood volume and haemoglobin in baby at birth
64
What is rupture of membranes (ROM)
When the amniotic sac has ruptured
65
What is spontaneous rupture of membranes
Amniotic sac has ruptured spontaneously
66
What is pre-labour rupture of membranes
Amniotic sac has ruptured before the onset of labour
67
What is pre-term, pre-labour rupture of membranes (P-PROM)
Amniotic sac has ruptured before the onset of labour and before 37 weeks gestation
68
What is prolonged rupture of membranes
Ambiotic sac ruptures more than 18 hours before delivery
69
How is preterm prelabour ROM diagnosed
Speculum exam - reveals pool of amniotic fluid in the vagina
70
How is preterm prelabour ROM diagnosed
Speculum exam - reveals pool of amniotic fluid in the vagina
71
Management of preterm prelabour ROM
Prophylactic Abx, induction of labour may be offered from 34 weeks to initiate onset of labour
72
How is preterm labour with intact membranes diagnosed
Speculum exam - cervical dilatation - less than 30 weeks then clinical assessment is enough but id after 30 weeks then transvaginal US is needed
73
Management of preterm labour with intact membranes
Fetal monitoring, tocolysis, maternal corticosteroids, IV Mg sulphate and delayed cord clamping/milking

Obstetrics (8 decks)

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