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Monica’s Part 2 > Labour > Flashcards

Labour Flashcards

(93 cards)

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1
Q

What is the most frequent cause of severe early onset infection on newborn infants

A

Streptococcus agalactiae in less than 7 days of age

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2
Q

Antidote to Mg toxicity

A

Antidote to MG tox is 10ml , 10% calcium gluconate or 10 ml 10% calcium chloride given by slow IV injection

Symptoms are - not able to move legs, flushed nausea, drowsy

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3
Q

% of women who are carriers of GBS

A

30%

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4
Q

Antidote to local anaesthetic toxicity

A

Intralipid 20% 1.5ml/kg

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5
Q

% of women who will labour spontaneously by 41 +6

A

99% @ 41 to 41+6

40-40+6=6 82%
39-39+6=6 50%

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6
Q

When to not do regional anesthesia

A

Plates <80, INR >1.4

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7
Q

What is the survival rate after maternal cardiac arrest

A

50%

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8
Q

Side effects of remi

A

Resp depression 32%
O2 status <90% =0.9 5%

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9
Q

Side effects of epidural

A

Failure MC
Pruritus and shivering
Significant hypotension 1in 50
Sever headache 1 in 100
Temp nerve damage 1 in 1000

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10
Q

When to transfer to a CLU or obstetric led unit

A
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11
Q

What to do if SROM and prev CS

A

Expectant management for 24h if no spontaneous labour for EMCS

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12
Q

What kind of aneasthesia for CS for women who have mWHO class 3 /4 disease

A

Los dose combined spinal /epidural anesthesia

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13
Q

What to do of Post Mortem shows endomyocardial fibro-elastosis

A

Check maternal anti RO and anti La antibodies

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14
Q

What is the % of women who will be negative at delivery if tested positive for GBS at 35-37W

A

17-25%

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15
Q

% of women who are negative at 35-37w with GBS will be positive at delivery

A

5-7%

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16
Q

What you need when sitting regional analgesia

A

BP monitoring
Continuous EFM
Hourly check of sensory block
IV access

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17
Q

Meds for seizures in pregnancy

A

1st) IV lorazepam 4mg bolus then another dose 10-20 min further (0.1mg/kg)

Or diazepam 5-10mg IV slow

If no IV access - diazepam 10-20 mg rectally repeated once 15 min later if there is a continued risk of status OR midazolam 10mg as buccaneers preparation are suitable

If still no control for Phenytoin - 10-15mg/kg by IV infusion usual dose for a adults is 1000mg

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18
Q

What is the risk of seizures in labour for with with epilepsy

A

2% and within 24 h of delivery in a further 1-2%

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19
Q

Risk factors of having a baby with EOGBS

A

Prev baby with GBS disease
Discovery of maternal GBS carriage through bacteriological investigation during pregnancy ex urine
Infection or swab talent to investigate a vag discharge
Preterm birth
Prolonged SROM
Suspected maternal intrapartum infection including suspected chorioamnionitis

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20
Q

Observation in different obstetric emergencies

A
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21
Q

NICE recommends elective CS for what type of disease

A

Any disease of the aorta assessed as high risk
Pulmonary arterial hypertension
NYHA class III or IV heart disease

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22
Q

Borders of the pelvic outlet

A

Anterior - pubic arch
Lateral - Ischial tuberosity
Posterior- tip of the coccyx

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23
Q

What is the widest diameter of the pelvis

A

Pelvic inlet - transverse diameter

PLANES

Pelvic Inlet= transverse diameter 13cm , antero-posterior diameter 11cm

Pelvic mid cavity - transverse and AP diameter 11cm

Pelvic outlet - transverse 11cm , AP 12.5

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24
Q

How to auscultate in labour

A

In the established 1st stage

Immediately after a contraction for at least 1min , at least every 15 min and record it as a single rate
Record accelerations and decelerations if heard

Palpate the maternal pulse hourly or more often if there are any concerns to differentiate between the maternal and fetal heartbeats

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25
When and how to stop warfarin pre delivery
Stop it 2 weeks before birth or by 36w Do this in hospital and after stopping 24h later start LMWH using a twice daily regimen at a dose based on the most recent weight available Increasing the dose of LMWH according to anti Xa levels : do this by checking anti Xa levels each day 3-4h after a dose of LMWH aiming for a peak anti Xa level between 1.0 and 1.2IU/ml - checking that the anti Xa level reborn a dose of LMWH (trough level) is above 0.6IU/ml -rechecking anti Xa levels weekly once the target anti Xa level is achieved
26
Borders of the pelvic inlet
Anterior: pubic symph Lateral: iliopectineal line Posterior: sacral promontory
27
Risk of stillbirth at 41w if over 40 years vs 35 year old
RR:3 If under 35- SB rate of 0.75 in 1000 If aged >40, 2.4 in 1000 women equating to a relative risk of 3.3
28
What is the risk of DIC int he first 4 weeks after IUD
10% , and rises to 30 % afterwards
29
If woman was GBS positive bacteriuria in a prev preg. What is the GBS carriage % in this preg.
50% it is assumed , that 50% of women will be recurrent carriers, the risk of EOGBS disease should be approx 2-2.5 times that quoted for the total population. The risk of EOGBS disease in the baby in this circumstance is likely to be around 1 in 700 to 1 in 800 - so at this level some would chose IAP and some would not A positive bacteriological test at 36w approx would indicate a risk of 1 in 400 but the risk would be 1 in 5000. If the mother is GBS negative.
30
What is the change of a low risk nulliparous women to be transferred to a CLU from home birth
45%
31
What are contraindications for cabergoline and bromocriptine
PET and hypertension - can even cause intracerebral bleeding
32
Does a coroner need to know about a stillbirth>
No , only if no medical professional around at the time of birth , or if the stillbirth involved a criminal act such as assault , and can request to expedite the post mortem Parents mom or dad are responsible for registering the stillbirth within 42 days but limit of 3 months for exceptional circumstances - this responsibility can be delegated to health professionals like MW or doctor present at the birth or bereavement officer
33
34
What has the highest risk of hyperstimulation
High dose miso 50mcg or. More
35
Adrenaline dose for IM
IM 1:1000 , 500 mcg (0.5ml) Can repeat after 5 min IV- 50 mcg bolus (0.5ml of 1:10 000 solution) + Chlophenamine 10mg, hydrocortisone 200mg
36
Shock at V tachy or V systole how much?
1 shock at 200 J biphasic /360 monophasic
37
What to do if auscultation in labour is abnormal
If FH increases 20 a min or more or decels , you should carry out intermittent fasting auscultation more frequently or example after 3 consecutive contractions
38
Uterotonics to avoid with cardiac diseases For example. What is the second line uterotonic for pulmonary arterial hypertension
Miso
39
What is the risk of still birth if you’re over 40
7.6 per 1000 maternities 35-39 = 5.5 per 1000maternities
40
What has the lowest risk of caesarean section and uterine hyperstimulation
Oral miso 25mcg every 2 hours
41
Largest head diameter
Brow - 13.5cm - verticomental Suboccipitobregmatic - vertex flexed= 9.5cm Occipitofrontal - vertex neutral flextion = 11cm Submentobregmatic = face is 9.5cm
42
MC cause for maternal collapse ?cardiac arrest
Haemorrhage Incidence of 6 in 1000 maternities
43
What to do if taking steroids and in labour for example in admissions disease
Continue regular oral steroids and add IV hydrocortisone 50mg QDS until 6 h after birth - if on minimum 5mg daily for 3 weeks Start in 1st stage of labour
44
What is the % of babies with no diasability born at 24w
22%
45
What to watch out for if mom in labour with known immune throbocytopaenia had has low platelets
For baby don’t do : Inform neonatal team Don’t do FBS Don’t use FSE Don’t use ventouse Don’t use mid cavity of rotational forceps CS may still cause baby to bleed Measure the platelet count in the umbilical cord at birth
46
IOL what does it prevent for LFD
Shoulder dystocia Nice recommends that women without diabetes and with LFD be offered a discussion about birth including , IOL, CS, nothing Explain that there is uncertainty about the benefits of risk of IOL compared to expectant - with IOL risk of 3rd.4th deg tears in increased - risk is the same with both options regarding baby death brachial plexus injury, `EMCS
47
What is the survival rate from the onset of labour of babies born at 24w
36% 25weeks =62%
48
What is the chance of transfer to an obstetric unit for a multi-around women wanting a home birth
12%
49
What % of CS were classical at 24 weeks
20% <5% at 30w <1% from 34w
50
IOL with uncomplicated gestational diabetes GDM ? When
No later than 40+6
51
What does water immersion do in labour
Shortens first stage of labour and required less neuraxial anesthesia , all other factors like perineuym, CS no difference
52
How do sickle cell women deliver and when
Via IOL AT 38weeks
53
How to deliver moms over 40
RCOG recommends planned delivery at term for maternal age over 40
54
When to delivery women with CKD? Ex stage 5
IOL at 38w
55
When to IOL induce post dates
41w
56
When to deliver if FGR and absent end diastolic flow
Consider birth at 32w and absolute by 34w ?CS - check guideline
57
When to deliver women with Type 1 or type 2 diabetes ?
Between 37w and 38+6 could be IOL or CS based on size/RF
58
When to deliver if wants ELCS and prev spront del at 37w
ELCS at 39w still 1 in 10 women may labour pre ElcS but still not indication for earlier CS
59
If chorio and GBS pos in labour
Do cef plus met as in. Broad spectrum antibiotics
60
If hypotension and bradycardia post del with placenta still in situ
Think uterine inversion
61
If 2nd stage of labour and chest pain and hypoxia then unresponsive
VTE
62
Very high BMI and struggling in labour
Combined spinal - epidural anaesthetic
63
What infection is a planned C section recommended
If mom has a concurrent maternal HIV and hep C infection - offer a ELCS to reduce mother to baby transmission of hepatitis C and HIV
64
What gestation can you use vacuume extraction ? Like kiwi or ventouse
Vacuum birth to be avoided below 32w and used with caution between 32-36w Can use forceps
65
What is the incidence of assisted vaginal birth in nulliparous women in the UK
30% - almost one in every 3 nulliparous women will delivery with an instrument Lower rates are found in a midwife led setting
66
Factors that increase the chance of assisted vaginal birth
Epidural analgesia - the most! Epidural analgesic in the latent phase of labour Upright or lateral position on the second stage of labour Discontinuing epidural analgesia Use of oxytocin at 6cm dilation onwards
67
How to decrease risk of endometritis -post CS
Use aqueous iodine vaginal prep before caesarean birth if SROM or aqueous chlorhexidine if the first one not available
68
Contraindications for internal podalic version
First twin Cervix not fully In pain Single baby EFW >4kg Short mom
69
What is the least common neonatal complication associated with instrumental delivery
Intracranial haemorrhage
70
What is the risk of a renal transplant injury at CS
1-2% Consideration should be for a midline skin incision to reduce risk of trauma to the allograft Uterine incision will usually be a transverse lower segment incision The renal graft can also be located with USS right before the CS
71
What is the incidence of assisted vaginal birth of women in the UK
15%- forceps or vacuum
72
How much is too much moulding or Caput to delivery safety and should abandon and do EMCS
If caput or moulding +3 or more should not delivery vagninally = parietal bones are overlapping and are irreducible ie cephalopelvic disproportion Can do vag del if 2+ caput or moulding = parietal neons are overlapped but easily reduced
73
Indication for assisted vaginal birth for fetal reasons
Suspected feta compromise
74
Indication for assisted vaginal birth for maternal reasons
Nulliparous- lack of continuing progress for 3 hours (total of active and passive second stage labour) with regional analgesia or 2 hour without regional analgesia Parous women- lack on continuing progress for 2 hours (total of active and passive 2nd stage labour) with epidural or 1 hour without regional analgesia Maternal exhaustion or distress Medical indication to avoid valsalva manouevre Others are- very high BP, myasthenia gravis
75
Factors associated with shoulder dystopia Pre labour and intrapartum
Pre labour Prev SD Macrosomia >4.5kg DM Mat BMI >30 IOL Intrapartum Prolonged 1st stage Secondary arrest Prolonged second stage Synto augmentation Assisted vag delivery
76
If prev SD what is the risk higher compared to normal population
10 times higher
77
Complications of SD most common?
PPH- 11% 3rd and 4th deg tears- 3.9%
78
What is the mortality of umbilical cord prolapse
9%
79
What is ogilvie syndrome
Large bowel obstruction without a mechanical cause It is not specific to CS but can occur in any patient undergoing surgery and indeed has been reported in non surgical patients with serious underlying medical condition. Exact pathophysiology is unknown but it may be due to an imbalance in the autonomic innervation of the distal colon leading to atony and subsequent proximal dilation. During a cs Ogilvie syndrome may be caused by damage to the sacral parasympathetic nerve supply which runs close to the cervix vagina and broad ligament The classic presentation is progressive abdominal distension which may initially be painless and associated with varying degrees of constipation. As the caecum becomes more dilated the pain worsens localizing to the right hand side with associated tachycardia. Eventually there is caecal ischaemia perforation and peritonitis It is suggested that for caecal diameters of less than 10-12cm conservative management should be attempted but consider IV neostigmine For caecal diameters diameter of greater than 10-12cm the patient should have urgent colonic decompression with a rectal flatus tube
80
What to do if SROM and breech pre 37w
Inpatient expectant management with elective CS at 37w Can’t do ECV if SROM
81
Similar factors for CS and SVD
VTE MOH Postnatal depression Faecal incontinence occurring Moore than 1 year after birth compared to unassisted vag birth
82
What is more common with Full dilatation CS compared to operative vag delivery
Admission to NICU. 11% vs 6%
83
What are the disadvantages of cord blood transplantation
Most of cord blood has been for haematological malignancy in children- mostly for ALL and AML. Disadvantages are: Low number of haemopoietic progenitor cells and stem cell in each cord blood donation which may cause delayed engragment . This deficiency is being addressed by the use of multiple units of cord blood for transplantation and by efforts to expand the progenitor pool Lack of availability of subsequent donation of stem cell and or lymphocytes from graft donor in graft failure or disease relapse
84
What are the advantages of cord blood donation
Faster availability patient on average receive cord blood translplantation earlier than those receiving conventional bone marrow grafts Extension of the donor pool - cord blood transplantation will tolerate a mismatch of tissue types between donor and the recipient great than is acceptable with bone marrow or peripheral blood. Lower incidence of severity of graft vs host disease Lower incidence of viral transmission in particular cytomegalovirus and Epstein Barr virus Lack of donor attrition - bone marrow donors may change their mind over time and may no longer be available
85
% of women in the uk that have a CS
30%
86
Babies born via CS and SVD similar facts
Same for : NICU admission Infection Persistent verbal Daley Infant mortality up to 1 year
87
What % of women with a multiple preg aim for SVD but have a CS
35%
88
Can you do a forceps with a cord prolapse (if head is low)
Yes , watch out not to impinge the cord
89
If fetal Brady for second twin and cord prolapse how to deliver?
Internal podalic version and breech extraction
90
Do we do a CS for spontaneous labour if is breech? And almost fully
No GTG say not do and SVD is safer , its not recommended CS for breech at the threshold of viability is not routinely recommended
91
Haemophilia in baby - can’t do what?
Mid cavity and rotational forceps
92
Can you do mid cavity forceps on a 30 w baby
No do CS
93
If lesion at T3 with spinal cord injury how to deliver
Deliver with forceps-

Monica’s Part 2 (12 decks)

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