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Year 5-Obstretics > Labour > Flashcards

Labour Flashcards

1
Q

Labour defn?

A

painful uterine contractions accompany dilatation and effacement of cervix

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2
Q

how many stages does labour have?

A

3

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3
Q

First stage labour?

A

initiation to full cervix dilatation 10cm

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4
Q

second stage of labour

A

cervical dilatation to delivery of fetus

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5
Q

third stage of Labour?

A

delivery of placenta

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6
Q

what factors determine labour?

A

3 factors

Power - degree of force pushing fetus
passenger- fetus head diameter
passage - dimension of pelvis and resistance of soft tissue

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7
Q

Uterine contractions

A

45-60seconds every 2-4 minutes
pulling cervix up (effacement)

= dilatation

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8
Q

effacement?

A

thinning and shortening of cervix

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9
Q

The passage
bony pelvis
Pelvis inlet diameter

A

around 13 cm transverse
anteroposterior is 11cm

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10
Q

what is level of descent?

A

the landmark that is used is the ischial spines

this is measuring descent of head

level of descent of the head is known as the station in relation to ischial spines

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11
Q

what is station 0?

A

station 0 means head of fetus is at the ishcial spines

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12
Q

station -2 means?

A

head is 2cm above ischial spine level

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13
Q

anterior fontanelle

posterior?

A

bregma
occiput

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14
Q

what is vertex presentation?

A

maximal flexion of fetus head, head bowed

presenting diameter would be 9.5cm anterior fontanelle to below occiput

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15
Q

why must the fetus head rotate during delivery?

A

if sagital suture is transverse at point of entering pelvic inlet - fits best

but at outlet the sagittal suture must be vertical for head to fit to pass out

so rotation by 90degrees is needed to get this

delivering occiput-anterior

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16
Q

can you deliver occiput-posterior

A

yes but more complicated only 5%

you can’t deliver occipto transverse

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17
Q

oxytocin produced where?

A

posterior pituitary gland
aids stimulation of contractions

prostaglandins stimulate this and help reduce cervical resistance

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18
Q

First stage of labour is split into?

A

this stage involves rupture of membrane

latent stage: dilates to 4cm
active phase: 1cm/hr in nulliparous, 2cm/hr in multiparous (should not last longer than 16 hours?)

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19
Q

passive second stage

A

Dilatation of cervix to delivery of fetus

lasts till head reaches pelvic floor - rotation and flexion are done by now

can last a few minutes

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20
Q

active second stage

A

mother is pushing
pressure of head
40-20 mins

> 1 hour means spontanous labour won’t occur

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21
Q

placental delivery

A

lasts upto 15 mins
upto 500ml of blood loss is normal

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22
Q

10 steps of labour

A
  1. Descent
  2. Engagement – identified by abdominal palpation, foetal head is 3/5th palpable or less
  3. Neck flexion
  4. Internal rotation
  5. Crowning
  6. Extension of the presenting part
  7. Restitution
  8. External rotation
  9. Lateral flexion
  10. Delivery of the shoulders and foetal body
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23
Q

risk factors for foetal compromise?

maternal factors

A

previous C section
hypertension
PROM
vaginal blood loss
maternal sepsis/ chorioamniontis
GDM

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24
Q

hyperactive uterine activity
causes
imapct

A

fetal distress as placental blood flow is impaired

associated with abruption
prostaglandin use
too much oxytocin

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25
tocolytics
suppress uterine contractions
26
most common tocolytics
magnesium sulfate CCB - nifedipine NSAIDS: indomethacin b2 agonists : terbutaline / salbutamol (IV or subcut)
27
effects of tocolytics CCB
block calcium channels inhibits calcium ions reducing contractility - smooth muscle relaxation
28
effects of magnesium sulfate
neuroprotective - useful in preterm brain
29
effect of nsaids on prostaglandins
inhibit COX enzyme (this typically stimulates prostaglandin production) reduced prostagland levels relaxation of uterine muscles
30
fetal distress defn
hypoxia that might result in fetal death / damage if not reversed or delivered
31
how is fetal distress measured?
32
fetal distress steps
intermittent auscultation of fetal heart continoud CTG Fetal blood sampling delivery
33
when is Continous CTG indicated fetal factors
fetal growth restriction anhydramnios or polyhydramnios advanced gestational age small for gestational age non cephalic presentation
34
what is polyhydramnios what is a normal amount?
increased volume of amniotic fluid comprises of fetal urine output 500ml
35
causes of polyhydramnios?
anything that prevents fetus from swallowing (obstruction of oesophagus, neuro problems, atresia etc) increased lung secretions like in CF
36
types of pain relief medical
entonox (NO) opiates epidural
37
why is supine position avoided in pregnant women?
Gravid (heavy) uterus compresses main blood vessels > CO reduced> hypotension = fetal distress
38
what is aortacaval compression?
supine lay in a gravid women causing reduced CO and hypotension leading to fetal distress
39
fever of 38 degrees in labour?
risk of neonatal illness (? chorioamnionitis) >37.5 bad cultures of vaginal, urine and blood taken paracetamol given IV abx cTG monitoring
40
Bishop score of 8?
Favourable cervix likely to progress spontanously
41
Bishop score of <6?
induction needed offer vaginal prostaglandin
42
bishop score of 7?
ARM followed by IV oxytocin
43
prostaglandin E role in IoL
gel/slow release into psoterior vaginal fornix activates prostaglandin e2 soften cervix and dilates blood vessel
44
amniotomy?
amnihook (instrument used) ruptures waters then you give oxytocin within 2 hours
45
natural inductions?
membrane sweep releases physiological prostaglandins offered at 40 weeks for nulliparous 41 multiparous
46
indications for IoL Fetal causes:
prolonged pregnancy IUGR anterpartum haemorrhage prelabour term rupture of membranes
47
indications for IoL materno-fetal causes
pre-eclampsia maternal diabetes previous caesarian maternal request breech fetal macrosomia
48
contraindications for IoL
acute fetal compromsie CTG/lie placenta praevia!!!
49
prostaglandin e2 gel?
Prostin®
50
prostaglandin e2 pessary?
propess
51
what is cervical ripening balloon?
catheter inserted into cervix which can mechanical induce labour safe for baby less risk of uterine hyperstimulation
52
define risk for CTG maternal factors?
previous c-section pre-eclampsia antepartum haemorrhage post term pregnancy rolonged rupture of membrane >24 hours significant maternal disease
53
what is delay in first stage?
<1cm per 2 hours
54
how to manage delay?
ARM review in 2 hours oxytocin
55
types of delay?
primary dysfunctional labour secondary arrest of labour (progressed well then stopped) prolonged latent phase cervical dystocia
56
what is delay in second stage? Nulliparous women
from active second (cervix dilated to 10cm) 3 hours with epidural 2 without epidural
57
what is crowning?
when head no longer recededs between contractions
58
immediate care of neonate?
59
when do you need to start continuous CTG monitoring? contractions?
contractions last longer than 2 mins 5 or more contractions in 10 minutes
60
when do you need to start continuous CTG monitoring? infection risk factors
maternal pyrexia chorioamnionitis sepsis
61
when do you need to start continuous CTG monitoring? relating to maternal obs
pulse over 120 bpm on 2 occasions more than 30 mins apart severe hypertension >160/110 hypertension 140/90 protein 2+ and raised bp>140/90 fresh vaginal bleed abnormal pain blood stained liqour
62
when do you need to start continuous CTG monitoring? other
insertion of regional anaesthetic use of oxytocin
63
immediate care of newborn when is apgar score calculated? what is a normal score?
1 minute 5 minute >7 is good
64
what apgar score is most worrying?
0-3
65
when is vit K given? why?
immediately to prevent vit K dependent bleeding
66
apgar score
appearnace pulse grimace activity respiration
67
APGAR heart rate? what scores 2
>100 beats/min scores 2
68
APGAR score heart rate what scores 1?
<100 bpm
69
SCore 0 for APGAR
HR: absent RR: absent muscle tone: flaccid reflex: none colour: plae/blue
70
apgar score what scores 1?
<100bpm HR gasp/irregular : Respiratory effort flexion of limbs : muscle tone grimace : reflex irritability body pink , extremities blue : colour
71
what scores 2 on apgar?
>100beats per minute : HR regular strong cry : respiratory effort well flexed/ active : muscle tone cry/ cough : reflex irritability pink :colour
72
causes of PPH?
tone - atony most common tissue - retained products trauma - (laceration) thrombin - coagulopathy
73
how to manage meconium aspiration? no history of GBS?
observation recommended
74
41 week old delivery has asymmetrical patchy opacities on chest x-ray mother had a temp of 38 at delivery what is this? how to manage? what else can be offered ?
meconium aspiration sign of infection so IV ampicillin and gentamicin CPAP and/or oxygen therapy boluses of surfactant inotropes
75
what is prelabour term rupture of membrane also known as?
premature rupture of membrane so baby at term 37 weeks but waters break before uterine activity has started
76
what two signs in PROM indicate immediate IoL?
presence of meconium positive group b strep results (from vaginal swab?)
77
PROM management?
admit speculum (vaginal swab sent for infection) 4 hr temp 24hr foetal monitoring
78
how long can you give expectnat management for PROM (from when membranes rupture)?
24 hours 60& will deliver sponatanously
79
what is preterm prelabour rupture of membrane?
before 37 weeks rupture of membrane without uterine activity here you want to prevent and protect foetus because it is not fully developed particularly before 34 weeks
80
diagnostic Investigation for PPROM / PROM?
speculum (amniotic fluid pooling is diagnostic) look at os (open/closed) pooling then test IGFBP-1 / PAMG-1
81
if >30 weeks contractions are present and Os is closed whatd o you do? why? what does this tell you?
TVUSS for cervical length <15mm likely to preterm labour >15mm unlinkely to be preterm labour
82
can you offer tocolysis for P-PROM?
no due to increased risk of infection
83
Mx of P-PROM
admit (at least until 28 weeks then depends but seen 2/3x weekly) sterile speculum exam offer Abx: erythromycin (2nd line penicillin) offer maternal corticosteroids (IM betametasone 24mg) offer IV magnesium sulfate (if birth expected in 24 hours)
84
when in p-prom do you immediately offer IoL?
>34 weeks group b strep signs
85
what is abx given in pprom?
1st line erythromycin QDS 250mg 2nd line penicillin
86
dose of magnesium sulfate and why is it given in PPROM?
IV neuroprotection of foetus especially if <30 weeks effects after 30 weeks are unclear
87
corticosteroid in PPROM?
IM betametasone 24mg / in 2 doses 12 hours apart assists with lung maturation (if less than 34 weeks
88
risk factor for pprom /prom?
smoking sti previous hx multiple pregnancy
89
PROM risk of infection to neonate? how many women will go into labour by 24 hours complication?
1% compared to 0.5% of intact 60% attempt to induce at 24 hours risk of ascending infection
90
complication of pprom?
maternal: sepsis, cord abruption foetal: chorioamnionitis, cord prolapse, pulmonary hypoplasia, death
91
preterm labour can be classified into?
PTL : 32-37 very PTL: 28-32 weeks Extremely PTL: <28
92
causes of preterm labour?
infection overdistention of abdomen? polyhydramnios multiple pregnancy
93
predicting preterm labour how many factors? how many do you need to be offered prophylaxis?
previous Hx of spontanous birth <34 weeks mid trimester loss (>16 weeks ) cervical length <25mm on USS if 2 then defo offer if 1 then sugggest
94
prevention of pre term labour mx?
vaginal progesterone started 16-24 and continue till 34 weeks cervical cerclage
95
contraindications to rescue cervical cerclage?
bleeding infection uterine contractions
96
mx of preterm labour?
admit offer maternal steroids offer tocolytics Iv magnesium sulphate aim for delivery 37 weeks
97
tocolytic use in preterm labour?
1st line nifedipine (CCB) 2nd line atosiban oxytocin receptor antagonist
98
dose of magnesium sulphate?
4g over 5-15 mins IV infusion of 1g/hour continue till birth or 24 hours
99
antidote to mgso4
10ml 10% calcium gluconate over 10mins (and stop magnesium sulphate infusion
100
complications of pre term birth?
RDS > retinopathy of prematurity necrotising enterocolistis intraventricular haemorrhage periventricular leukomalacia
101

Year 5-Obstretics (16 decks)

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