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Labour Flashcards

1
Q

What are the 3 stages of labour

A

1 - start of contractions to full cervical dilation
2 - cervical dilation to birth of baby
3 - birth of baby to delivery of placenta

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2
Q

What are the 3 Ps of labour

A

Power, passengers, passage

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3
Q

Why are ischial spines important in delivery

A

2 things:

  1. station zero is when baby’s head is at ischial spine, can only do instrumental if baby’s head has reached this
  2. important for delivery PUDENDAL NERVE BLOCK
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4
Q

Why does foetal head rotate on its way down

A

Pelvic outlet is widest transversely and then AP. Therefore head rotates from transverse to AP on its way down. (this occurs in midpelvis)§

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5
Q

What are the four types of pelvis

A

Gynaecoid
Android (predisposes to failure of rotation)
Platypelloid (kid prefers occipito posterior)
Anthropoid (predisposes to failure of rotation)

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6
Q

What is the vertex

A

Usually presenting part

It’s the part in between ant and post fontanelles and where the parietal bones fuse

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7
Q

How do you describe descent

A

Position of posterior fontanelle in relation to pubic symphysis

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8
Q

Which position has the greatest presenting diameter

A

mento-vertical - 13cm

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9
Q

What are the actions of progesterone on the uterus

A

Prevent prostaglandin production
Inhibit gap junction formation
Prevent oxytocine release
PROMOTES QUIESCENT UTERUS

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10
Q

What two molecules are needed for labour

A

Oxytocin

Prostaglandin

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11
Q

What is the ferguson reflex

A

Pressure of foetal head on cervix makes maternal pit. secrete more oxytocin which causes contractions and further increases pressure

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12
Q

How is progesterone dethroned at the end of pregnancy

A

Oestrogen opposes prog actions
chorion starts making PG. - (increase calcium)
CRH conc. (from placenta) increases at the end of term which potentiates action of PG + Ox
Production of cortisol from foetus stimulates conversion of prog to oestrogen

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13
Q

What is the definition of labour

A

presence of painful contractions which lead to progressive cervical changes

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14
Q

What is the diagnosis of 1st stage

A

cervix 10cm

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15
Q

What are the 2 phases of 1st stage

A

latent (effacement of cervix to 3-4 cm dilation w/ contractions)
Active ( 3/4cm –> 10cm dilation)

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16
Q

What are the two phases of 2nd stage

A

Passive - time between mx cervical dilation and involuntary expulsive contractions (1-2 hours) head is high in pelvis
Acitve - urge to bear down (no longer than 2 hours)

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17
Q

What is a long 3rd stage

A

should take 5-10 mins

anything more than 60 mins is abnormal

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18
Q

How to gauge engagement

A

Palpate foetal head in abdomen (if >2/5 then not engaged)

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19
Q

Mechanism of labour

A 
engagement
descent
flexion of head
internal rotation
extension
restitution
external rotation
delivery of shoulders and foetal body
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20
Q

What are indications for increased foetal monitoring during labour

A 
Significant meconium 
Abnormal FHR
PV bleeding
If they're being augmented
Maternal pyrexia
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21
Q

What to look at in CTG

A

Baseline
variability
acceleration
deceleration

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22
Q

How to read CTG

A

All normal - reassuring
1 abnormal - suspiscious
2 abnormal - pathological CTG

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23
Q

How long after reaching full dilation (second stage) should baby be delivered?

A

Baby should be delivered 4 hours after start of stage 2

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24
Q

What is the management of 3rd stage

A

Active management - controlled cord traction to pull placenta out
Physiological - let mum do it (recommence active if >60 minutes or haemorrhage occurs)
If placenta retained go to theatre for manual removal of placenta under anaesthesia

25
What is primary arrest
Where woman doesn't progress into active phase of 1st stage - characterised by cervical dilation of less than 1cm per 2 hours. caused by poor contractions and cephalopelvic disorders
26
What is secondary arrest
Where progress in active first stage is good but then it stops (cervix doesn't dilate past 7 cm) -malposition malpresentation - cephalopelvic disorders
27
Definition of poor progress in 1st stage
dilation of less than 2cm in 4 hours Should be 1cm every 2 hours (can be down to any of 3 ps)
28
Mx of dysfunctional uterine activity
Aim for 4-5 contractions per 10 mins (if it's less than this) If not happening do ARM (examine every 2 not 4 hours in this case) If after 4 hours nothing has changed then give oxytocin (remember to give epidural before this) On oxytocin need constant foetal monitoring If no progress on oxy for 4-6 hours ECS§
29
What are you concerned about in poor progress of 1st stage in multip
malposition and risk of rupture
30
What suggest cephalopelvic disproportion
foetal head not engaged slow progress in presence of good contractions head poorly applied to cervix haematuria
31
Mx cephalopelvic disproportion
Can give oxy in primigravida with suspected CPD | NEVER in multip
32
Which presentaiton can you deliver
Face - should be ok Brow. - NO Shoulder - questionable
33
Who is at higher risk of malpresenation
HIGH PARITY | uterine rupture
34
Causes of abnormalities of birth canal
Undiagnosed fibroids | Cervical dystocia - cervix effaces but doesn't dilate cause of surgeries or something
35
Causes of poor progress of 1st stage
Dysfunctional uterine activity (MOST COMMON) CPD Malpresentation Abnormalities of birth canal
36
How long should it take to give birth from active second stage
Nullip - 3 hours Multip - 2 hours W
37
When to diagnose delay of second stage
If birth isn't imminent after 1 hour in multio 2 hours in nullip
38
Causes of poor progress in second stage
Secondary dysfunctional uterine activity Android pelvis Resitant perineum Persistent OP position
39
What is a RF for secondary delay
Epidural analgesia | Sometimes associated with maternal dehydration
40
Mx of secondary delay
In nullip - if no mechanical obstruction can give oxytocin IV In multip - full obstetrician review to assess whether you want to give oxytocin NB- by time delay of second stage has been diagnosed you should not be giving oxytocin, should diagnose and correct this at the start of second stage
41
When is meconium concerning
If it's bright green or black | if it's tenacious (thick and clingy)
42
What to do if pathological CTG
Immediate vaginal exam to exclude cord prolapse and malpresentation If cervix fully dilated can do instrumental If not then do foetal blood sampling If normal carry on for 30-60 mins If abnormal emergency CS
43
What are you looking for in foetal blood sampling
Level of acidosis If less than 7.2 it's foetal compromise 7.2-7.25 borderline 7.25 normal
44
Side effects of opiatae analgesia
Vomiting and nausea - give w/ antiemetic Delayed gastric emptying - interfere with GA Resp distress in foetus Can interfere with breastfeeding
45
Whis is NO not good in long term
Leads to hyperventilation, hypocapnia and potentially foetal hypoxia
46
What are indications of epidural
``` High risk of operative delivery maternal hypertension select maternal conditions multiple pregnancy prolonged labour and oxytocin use ```
47
Contraindications for epidural
Coagulopathy sepsis hypovolaemia
48
Complications of dural
Dural puncture Spinal haematoma Leakage of CSF into subarachnoid space - spinal headache Complete spinal anaesthesia - spinal headache Bladder dysfunction - CATHETERISE Hypotension - give IV fluids and vasopressors
49
When is rupture most likely to happen
In late first stage when being augmented or induced
50
Contraindications for VBAC
Relative (no more than 2): Need for induction 2 or more c sections Hx of CPD Absolute contraindications: Classical caesarean pervious uterine rupture
51
When to induce in PROM
>37 induce roughly 24 hours after PROM <34 need another reason to induce 34-37 case by case basis
52
What are the absolute contraindications for IOL
Placenta praevia | Foetal compromise
53
what is the bishop score
For induction | Looks at cervical changes (high score = more favourable cervix)
54
How to induce labour
PGE2 - most common (first line) ARM - only possible if cervix is beginning to dilate and efface. Don't do if presenting part is mobile and high IV syntocinon - offer if 2 hours after membranes rupture labour hasn't started (to increase til 3-4 contractions per 10 mins) Special circumstances: Mifepristone and misoprostol (often used following intrauterine foetal death Cervical sweep to break membrane and release prostaglandin. offered prior to formal measures especially from 40 weeks
55
Complications of induction
increased risk of uterine atony | foetal compromise due to uterine hyperstiulation as s/e of prostaglandin
56
Risk of ARM
cord prolapse
57
Monitoring during normal labour
``` 1st stage - every 15 mins foetal HR every 30 mins frequency of contractions every hour maternal HR every 4 hours - vaginal examination ``` 2nd stage - every 5 mins foetal HR every 30 mins frequency of contractions every hour - vaginal exam
58
counselling for VBAV
VBAC - positive predictors: hx of successful VBAC, normal size baby, reduce need for C section in further pregnancies Risks of VBAC - uterine rupture 1in 200, success ratea 70-75% Elective repeat c-section- risk of another CS, risk of placenta praevia/accreta in future pregnancies avoids risk of future emergency C section and uterine rupture

Obs and gynae (23 decks)

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