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Obstetrics > Labour > Flashcards

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
Q

What happens in the third stage of labour

A

Gentle pushing and expulsion of the placenta

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26
Q

How long is the third stage of labour

A

5 - 30 minutes

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27
Q

How much dilatation occurs in the transition phase of labour

A

7-10cm

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28
Q

What happens to the mucus plug in first stage of labour

A

‘Show’ = where is falls out and creates space for the baby to pass through

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29
Q

How is the onset of labour diagnosed

A

Show, rupture of membranes, regular painful contractions and dilating cervix

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30
Q

What are Braxton -Hicks contractions

A

Occasional irregular contractions of the uterus which are felt duing the second and third trimester

31
Q

Symptoms of Braxton-Hicks contractions

A

Tightening and mild cramping
Temporary
Not true contractions
Do not indicate onset of labour
Do not progress of become regular

32
Q

When is induction of labour indicated

A

41-42 weeks gestation
Prelabour ROM
IUGR
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
IUFD

33
Q

What is the Bishop Score

A

Used to determine whether to induce labour

34
Q

What are the options for inducing labour

A

Membrane sweep
Vaginal prostaglandin E2
Cervical ripening balloon
Artificial ROM
Oral mifepristone plus misoprostol

35
Q

What does a membrane sweep involve

A

Inserting finger into cervix to stimulate it and begin process. Produces onset of labour within 48 hours

36
Q

when is membrane sweep used

A

More of an assistance before full induction, used from 40 weeks gestation to attempt to initiate labour in women over EDD

37
Q

What does vaginal prostaglandin E2 involve

A

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
Q

What does a cervical ripening balloon involve

A

Silicone balloon which is inserted into cervic and infalted to gently dilate cervix

39
Q

When is cervical balloon ripening indicated

A

As alternate to prostaglandin, usually in women with previous caesarean, when prostaglandins have failed or multiparous women

40
Q

What does artificial ROM involve

A

Oxytocin infusion

41
Q

When is artificial ROM used

A

Reasons not to use prostaglandins or after the use of them

42
Q

When are mifepristone and misoprostol used

A

Induce labour when IUFD has occured

43
Q

What does Bishop score include

A

Cervical position
Cervical consistency
Effacement
Dilation
Baby’s station

44
Q

Monitoring during labour induction

A

CTG and bishop score

45
Q

What management options are there is there is slow or no progress of labour

A

Further vaginal prostaglandins
Artificial rupture of membranes
CRB
Elective Caesarean

46
Q

What is uterine hyperstimulation

A

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
Q

What is the criteria for uterine hyperstimulation

A

Individual uterine contractions lasting more than 2 minutes in duration.
More than 5 uterine contractions every 10 minutes

48
Q

What are the complications of uterine hyperstimulation

A

Fetal compromsie, emergency caesarean, uterine rupture

49
Q

What is cardiotocography

A

Used to measure the fetus heart rate and contractionso f the uterus

50
Q

What can sinusoidal CTG indicate

A

Severe fetal anaemia - often caused by vasa praevia

51
Q

What does engagement mean

A

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
Q

Two options for prophylaxis of preterm labour

A

Vaginal progesterone and Cervical cerclage

53
Q

What is the role of vaginal progesterone in preterm labour

A

Maintains pregnancy and prevents labour by decreasing activity of myometrium and stopping cervix remodelling in preparation for delivery.

54
Q

When is vaginal progesterone offered

A

Women with cervical length less than 25mm on vaginal USS between 16-24 weeks gestation

55
Q

How is vaginal progesterone given

A

As a gel or pessary

56
Q

What is cervical cerclage

A

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
Q

Indication for cervical cerclage

A

Cervical length less than 25mm between 16-24 weeks gestation, who have had previous prem birth or trauma

58
Q

What is tocolysis used for

A

Nifedipine is a CCB which suppresses labour and blocks contractions. Used as a short term measure between 24-34 weeks

59
Q

What are maternal corticosteroids used for

A

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
Q

What drugs and dose are used for maternal corticosteroids

A

Two doses of betamethasone 24 hours apart for example

61
Q

What is IV magnesium sulphate used for

A

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
Q

How is IV magnesium sulfate given and monitoried

A

Bolus followed by infusion of up to 24 hours and close monitoring every 4 hours due to toxicity

63
Q

What is delayed cord clamping / cord milking

A

Increases circulating blood volume and haemoglobin in baby at birth

64
Q

What is rupture of membranes (ROM)

A

When the amniotic sac has ruptured

65
Q

What is spontaneous rupture of membranes

A

Amniotic sac has ruptured spontaneously

66
Q

What is pre-labour rupture of membranes

A

Amniotic sac has ruptured before the onset of labour

67
Q

What is pre-term, pre-labour rupture of membranes (P-PROM)

A

Amniotic sac has ruptured before the onset of labour and before 37 weeks gestation

68
Q

What is prolonged rupture of membranes

A

Ambiotic sac ruptures more than 18 hours before delivery

69
Q

How is preterm prelabour ROM diagnosed

A

Speculum exam - reveals pool of amniotic fluid in the vagina

70
Q

How is preterm prelabour ROM diagnosed

A

Speculum exam - reveals pool of amniotic fluid in the vagina

71
Q

Management of preterm prelabour ROM

A

Prophylactic Abx, induction of labour may be offered from 34 weeks to initiate onset of labour

72
Q

How is preterm labour with intact membranes diagnosed

A

Speculum exam - cervical dilatation - less than 30 weeks then clinical assessment is enough but id after 30 weeks then transvaginal US is needed

73
Q

Management of preterm labour with intact membranes

A

Fetal monitoring, tocolysis, maternal corticosteroids, IV Mg sulphate and delayed cord clamping/milking

Obstetrics (8 decks)

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