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5 - OBG > Labour > Flashcards

Labour Flashcards

(51 cards)

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1
Q

what factors are monitered throughout labour?

A

Foetal HR
Contractions
Maternal HR
Maternal BP
Vaginal examination
Vulva tearing

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1
Q
A
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2
Q

The 1st stage of labour is made up of 3 phases.

What happens in the active phase?

A

Latent phase : 0-3cm dilated, 0.5cm/hr with irregular contractions

Active phase : 3-7cm dilated, 01cm/hr with regular contractions

Transition phase : 7-10 cm dilated, 1cm/hr with strong contractions

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3
Q

When is early labour beneficial?

A

Maternal request

PProm and when labour doesnt start within 18-24 hours

Fetal growth restriction

Pre-eclampsia

Obstetric cholestatis

Intrauterine fetal death

Existing diabetes

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4
Q

When is induction of labour not recommended

A

PPROM

Breech or transverse lie

Severe IUGR

Suspected foetsl macrosomia

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5
Q

How is artifical ROM used for induction?

A

Membrane sweep:
insert finger - stimulate cervix - prostoglandin release

Vaginal prostaglandins E2:
stimulates cervix + uterus, tablet or gel 1 dose, followed by 2nd dose after 6 hours

Cervical ripening balloon:
Silicone balloon in cervix - inflate *if E2 use C/I

**Artificial rupture of membranes: if E2 C/I: oxytocin

IV syntococin: 2 hours after ROM if labour has not started**

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6
Q

Vaginal prostaglandins are used for induction of labour, what is the complication?

A

**Uterine hyperstimulation **(single contraction over 2 mins or 5+ in 10 mins)

Can cause foetal hypoxia by compressing umbilical and placental vessels

  • continuous CTG, remove E2s, GIVE TOCOLYTICS (terbutaline)
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7
Q

When is induction of labour offered?

A

If over due date 41 weeks

or when useful

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8
Q
A
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9
Q

When 2nd stage of labour is made of 2 phases, what happens in the passive phase?

A

Passive phase : one full dilatation until the head reaches pelvic floor and ends with the onset of involuntary expulsive contractions (no more urge to push)

Active phase : begins with onset of involuntaery expulsive contractions and ends with the birth of the baby (maternal urge to push)

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10
Q

What factors are monitered during 1st stage of labour?

A

15 mins Foetal HR + 30 mins contraction frequency + 1 hourly maternal HR,BP, vaginal exam + 4 hourly maternal temp

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11
Q

What to do if in stage 1 of labour there is <1cm over 2 hours dilation?

A

Depends on membranes:

if membranes intact : ARM (artifical rupture of membranes) and review in 2 hours

if membranes ruptured : oxytocin

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12
Q

APGAR score categories?

A

Heart rate
Resp effort
Muscle tone
Reflex irritability
Colour

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13
Q

How are vaginal prostaglandins used for induction?

A

Membrane sweep:
insert finger into cervix to stimulate cervix - physiological protaglandins
**
Vaginal prostaglandins E2:
stimulates cervix and uterus, given as tablet or gel as 1 dose, followed by 2nd dose after 6 hours or 1 24hr pessary
**
Cervical ripening balloon:
silicone balloon into cervix and inflate it (use of prostaglandins C/I)

Artifical rupture of membranes:
if use of prostaglandins C/I : follow with oxytocin if it hasnt kicked in after 2 hrs

IV syntoconin:
offered 2 hours after ROM if labour not ensued

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14
Q

How may the active phase of the 1st stage of labour differ in nulliparous and multiparous women?

A

Rate of dilation

1cm/hr in nulli

2cm/hr in multi

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15
Q

During the 1st stage of labour what pain relief can be given in hospital?

A

Entonox*

Remifentanil

Epidural

*s/e nausea, lightheaded, dry mouth

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16
Q

What is Bishop score
- high chance of spontaneous labour
- low chance of spontaneous labour so induction needed

A

Assessment of cervix to determine whether induction needed

8+ = high chance
6 - = offer IOL with vaginal E2 then reassess

if between 6-8 = offer IOL with arm then add a oxytocin infusion

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17
Q

What are the mechanism of labour?

A
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18
Q

The 1st stage of labour is made up of 3 phases - what are they named?

A

Latent phase : 0-3cm dilated, 0.5cm/hr with irregular contractions

Active phase : 3-7cm dilated, 01cm/hr with regular contractions

Transition phase : 7-10 cm dilated, 1cm/hr with strong contractions

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19
Q

2nd stage of labour lasting more than 3+ after the full dilation - what do you do?

A

Episiotomy before forceps

forceps : worse trauma for mother, done if baby is in occipito anterior position and fully engaged

3 pull attemps then -> c section

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20
Q

When would you give oxytocin in stage 1 labour?

Study These Flashcards
A

If membranes have ruptured and yet cervix is not dilating appropriately

21
Q

Newborn resuscituation method? (6 steps)

Study These Flashcards
A
  1. Dry the baby
  2. Assess tone, breathing, heart rate (APGAR at 1,5,10 mins)
  3. If gasping or not breathing, give 5 inflation breaths
  4. Reassess for increase in HR
  5. Chest compression 3:1
  6. Reassess HR every 30s, consider IV access and drugs
22
Q

If intrauterine fetal death has occured what is given to induce labour?

Study These Flashcards
A

Oral mifepristone (anti-progesterone)
+
Misoprostal (prostaglandin)

23
Q

When is IV syntoconin used for induction?

Study These Flashcards
A

Membrane sweep:
insert finger into cervix to stimulate cervix - physiological protaglandins

Vaginal prostaglandins E2:
stimulates cervix and uterus, given as tablet or gel as 1 dose, followed by 2nd dose after 6 hours or 1 24hr pessary

Cervical ripening balloon:
silicone balloon into cervix and inflate it (use of prostaglandins C/I)

**Artifical rupture of membranes:
if use of prostaglandins C/I : follow with oxytocin if it hasnt kicked in after 2 hrs

IV syntoconin:
offered 2 hours after ROM if labour not ensued**

given in conjunction with ARM

24
How are cervical ripening balloon used for induction?
membrane sweep: insert finger into cervix to stimulate cervix - physiological protaglandins Vaginal prostaglandins E2: stimulates cervix and uterus, given as tablet or gel as 1 dose, followed by 2nd dose after 6 hours or 1 24hr pessary ** Cervical ripening balloon: silicone balloon into cervix and inflate it (use of prostaglandins C/I)** Artifical rupture of membranes: if use of prostaglandins C/I : follow with oxytocin if it hasnt kicked in after 2 hrs IV syntoconin: offered 2 hours after ROM if labour not ensued
25
What 5 methods can be used for induction of labour?
Membrane sweep Vaginal E2s Cervical ripening balloon ARM +/- iv syntoconin
26
What factors are in the Bishop score?
Dilation Consistency of cervix Effacement Position of cervix Foetal station of presenting part
27
Why is bethamethasone given for preterm birth management?
Admission to antenatal ward -> **maternal corticosteroids (2x 12mg IM betamethasone 24 hrs apart) = Accelerates fetal lung maturation** -> tocolytics : delays delivery enough to give corticosteroids (1st line nifedipine - CCB) (2nd line atosiban (oxytocin receptor antagonist) ** == so first step in management : Nifedipine + bethamethasone** -> IV magnesium sulphase (neuroprotection) if birth expected within 24 hours
28
Why is IV magnesium given for preterm birth management?
Admission to antenatal ward -> maternal corticosteroids (2x 12mg IM betamethasone 24 hrs apart) -> tocolytics : delays delivery enough to give corticosteroids (1st line nifedipine - CCB) (2nd line atosiban (oxytocin receptor antagonist) == so first step in management : Nifedipine + bethamethasone **-> IV magnesium sulphase (neuroprotection) if birth expected within 24 hours **
29
How to manage pre-term birth?
Admission to antenatal ward -> maternal corticosteroids (2x 12mg IM betamethasone 24 hrs apart) -> tocolytics : delays delivery enough to give corticosteroids (1st line nifedipine - CCB) (2nd line atosiban (oxytocin receptor antagonist) == so first step in management : Nifedipine + bethamethasone -> IV magnesium sulphase (neuroprotection) if birth expected within 24 hours
30
How to prevent preterm birth
Prophylactic vaginal progesterone, start between 16-24 weeks gestation and continue till 34 weeks Can also do prophylactic or rescue cervical cerclage
31
Risk factors of preterm birth?
Previous preterm birth Short cervix <25 Multiple pregnancy previous EMCS
32
How to diagnose preterm labour?
<37 weeks gestation will have short cervix <15mm at <30/40
33
During the 1st stage of labour prior to admitting the mum what pain relief can be given?
Paracetamol Co-dydramol or pethidine
34
What is delayed or early cord clamping?
In 3rd stage of labour cord should be clamped 1-5 mins after delivery early = <1min later = >5min
35
When is oxytocin given in stage 3 of labour?
10 IU IM Oxytocin after the birth of the anterior shoulder Deferred cord clamping (after 1 mins but less than 5 mins) controlled cord traction to remove placenta
36
Why do you not do a ventouse in <34 weeks
Greater risk of haemorrhage in the new born hence why you do not use in <34 weeks due to intracranial haemorrhage risk
37
What does prolonged ventouse delivery risk?
Greater risk of haemorrhage in the new born hence why you do not use in <34 weeks due to intracranial haemorrhage risk
38
how to decide between ventouse and forceps?
Forceps if baby is in OA : occipito-anterior position Ventouse if baby is in OP: occipito-posterior position
39
Which is better ventouse or forceps?
Forceps has a higher success rate Forceps has more risk of trauma to mother Ventouse has more risk of trauma to baby
40
2nd stage of labour should last around 1 hour. How long do you wait before considering instrumental delivery or C-section?
3 hours
41
What is Fetal fibronectin used for?
It is a protein produced by the fetus that helps the amniotic sac attach to the uterine lining **Levels of fFN can predict risk of preterm birth **
42
What factors are monitered for during 3rd stage of labour?
maternal obs document volume of vaginal BL examine placenta Inspect vulva for tears
43
How to promote delivery of the placenta if its taking a while
Usually 5-10 mins up till 1 hour - IM syntocinon and breast feeding can be used to stimulate spontaneous expulsion If after 1 hour the placenta is still retained, patient should be taken to theatre and placenta removed under general anaesthesia
44
How long does the 2nd stage of labour last on average and how may this differ in nullips vs multips
1 hour 40 mins in nullips 20 mins in multips
45
The 2nd stage of labour is made of up two phases, What happens in the active phase
Passive phase : one full dilatation until the head reaches pelvic floor and ends with the onset of involuntary expulsive contractions (no more urge to push) **Active phase : begins with onset of involuntaery expulsive contractions and ends with the birth of the baby (maternal urge to push) **
46
What occurs during the 2nd stage of labour in one sentence?
After the cervix has dilated 10cm till the delivery of the baby
47
What are the signs of labour?
Show Rupture of membranes Regular + painful contraction Dilating cervix on examination
48
What are braxton-hicks contractions?
Painless contractions with no cervical change may have occassional irregular contractions felt during the 2nd and 3rd trimester, no true contractions that indicate the onset of labour
49
What is the cervical 'show' ?
The 'show' is a mucus plug in the cervix preventing bacteria from entering the uterus during pregnancy, this falls out creating space for the baby to pass
50
What is the 1st stage of labour in one sentence?
Onset of labour with true contractions -> 10cm cervical dilation

5 - OBG (24 decks)

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