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3- Reproduction > Labour and Delivery > Flashcards

Labour and Delivery Flashcards

1
Q

premature labour

A

birth before 37 weeks gestation.

Considered viable from 24 weeks
Extreme preterm: <28 weeks
Very preterm: 28-32 weeks
moderate/late preterm: 32-37 weeks

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2
Q

prophylaxis of preterm labour

A

vaginal progesterone
- decreases activity of myometrium and preventing cervix remodelling

Cervical cerclage
-stitch in cervix to add support and keep it closed

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3
Q

preterm prelabour rupture of membranes

A

amniotic sac rupture, releasing amniotic fluid, before the onset of labour and in a preterm pregnancy

management; prophylactic Abx (erythromycin)

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4
Q

preterm labour with intact membranes

A

regular painful contraction and cervical dilatation without rupture of amniotic sac.

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5
Q

management of preterm labour with intact membranes

A

Fetal monitoring (CTG)
Tocolysis with Nifedipine
Maternal corticosteroids (<36 weeks gestation)
IV magnesium sulphate (<34 week gestation)
Delayed cord clamping

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6
Q

Tcolysis

A

Using medications to stop uterine contractions.

Nifedipine
-CCB: medication of choice for tocolysis

Atosiban if Nifedipine contraindicated

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7
Q

breech presentation (+types)

A

presenting part of foetus is legs and bottom

Complete
-legs fully flexed at hips and knees

Incomplete
- one leg flexed at hip and extended at knee

Extended breech

  • Frank breech
  • Both legs flexed at hip and extended at knee

Footling breech
- foot presenting through cervix with leg extended

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8
Q

management of breech

A

before 36 weeks
- often turn spontaneously: no breech required

External Cephalic Version

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9
Q

active management of third stage

A

physiological management

Active management
- dose of intramuscular oxytocin to help uterus contract & careful traction to umbilical cord to guide placenta out of uterus & vagina

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10
Q

amniotic fluid embolism

A

Rare
Amniotic fluid passes into mother’s blood.
usually occurs around labour and delivery.
Amniotic fluid contains foetal tissue, causing immune reaction from the mother.

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11
Q

presentation of amniotic fluid embolism

A 
SOB
hypoxia
hypotension 
coagulopathy
haemorrhage
tachycardia 
confusion 
seizures
cardiac arrest
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12
Q

management of amniotic fluid embolism

A

supportive

ABCDE approach

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13
Q

c-section most common skin incision

A

transverse lower uterine segment incision

Blunt dissection is used after initial incision with scalpel.

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14
Q

cord prolapse

A

umbilical cord descends below presenting part of the fetus and through the cervix into the vagina, after rupture of the fetal membranes.
significant danger of presenting part compressing cord, resulting in fetal hypoxia.

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15
Q

cord prolapse risk factor

A

Abnormal lie after 37 weeks gestation

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16
Q

cord prolapse management

A

Emergency c-section

Tocolytic medication to minimise contractions whilst waiting for delivery by c-section

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17
Q

oxytocin in labour

A

stimulate ripening of cervix and contractions of uterus.

Infusions are used to 
0induce labour
-progress labour 
-imrpove frequency and strength of uterine contractions 
-prevent/ treat postpartum haemorrhage
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18
Q

ergometrine in labour

A

stimulates smooth muscle contraction.

Useful for delivery of the placenta and to reduce postpartum bleeding.
Only used after delivery of baby

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19
Q

prostaglandins in labour

A

stimulate contraction of uterine muscles

Example: Dinoprostone
Used for induction of labour

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20
Q

nifedipine in labour q

A

CCB that reduces smooth muscle contraction in blood vessels and the uterus

reduces BP in hypertension and pre-eclampsia
-tocolysis in premature labour

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21
Q

terbutaline in labour

A

beta-2 agonist

acts on smooth muscle of uterus to suppress uterine contractions

used for tocolysis in uterine hyperstimulation

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22
Q

carboprost in labour

A

synthetic prostaglandin analogue

Stimulate uterine contractions

AVOID in patients with asthma

given as deep IM injection in postpartum haemorrhage if ergometrine and oxytocin have been inadequate

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23
Q

tranexamic acid in labour

A

antifibrinolytic

Reduces bleeding

Prevention and treatment of postpartum haemorrhage.

24
Q

delay in first stage of labour

A

<2cm of cervical dilatation in 4hrs

25
delay in 2nd stage of labour
Active (pushing phase) lasts >2 hours in nulliparous women >1 hour in multiparous wome
26
delay in third stage
>30 minutes with active management (IM oxytocin and controlled cord traction) >60 minutes with physiological management
27
management of failure to progress
amniotomy (artificial rupture of membranes) oxytocin infusion instrumental delivery c-section
28
options for induction of labour
Membrane sweet Vaginal prostaglandins E2 (dinoprostone) Cervical ripening balloon (CRB) Artificial rupture of membranes+ oxytocin infusion
29
monitoring during induction of labour
CTG - assess fetal heart rate and uterine contractions before and during induction of labour Bishop score -before and during induction of labour to monitor progress
30
pain relief in labour
Simple analgesia Gas & air (entonox) IM pethidine/ diamorphine Epidural
31
perineal tears
Occurs where the external vaginal opening is too narrow to accommodate the baby. leads to skin and tissues in that area tearing as the baby's head passes.
32
degrees of perineal tears
first degree - injury limited to frenulum of labia minor and superficial skin 2nd degree - includes perineal muscles, but doesn't affect anal sphincter 3rd degree - Includes anal sphincter but not rectal mucosa - 3A: <50% external anal sphincter affected - 3B >50% external anal sphincter affected - 3c: external and internal anal sphincter affected 4th degree -includes rectal mucosa
33
management of perineal tears
First degree; do not require sutures Sutures to correct the injury Reduce risk of complications - Broad-spectrum AB - Laxative - physio - follow-up
34
complications of perineal tear
Short-term - pain - infection - bleeding - wound dehiscence or wound breakdown Long-term - urinary incontinence - anal incontinence and altered bowel habit - dyspareunia - psychological consequences
35
Epiosiotomy
Cuts perineum before delivery
36
perineal massage
reduce risk of perineal tears | massaging skin and tissues between vagina and anus
37
postpartum haemorrhage
Loss of >500ml after vaginal delivery >1000ml after c-section
38
Cause of postpartum haemorrhage
tone (uterine atony) trauma (perineal tear) Tissue (retained placenta) thrombin (bleeding disorder)
39
management of postpartum haemorrhage (stabling patient)
obstetric emergency ABCDE approach insert two large-bore IV cannulas Bloods: FBC, U&E, clotting screen Group and cross match 4 units of blood Warmed IV fluid and blood resuscitation as required Oxygen FFP (clotting abnormalities or after 4 units of blood transfused) Severe:activate major haemorrhage protocol
40
management of postpartum haemorrhage (stop bleeding)
Mechanical - rubbing uterus to stimulate uterus contraction - catheterisation Medical - oxytocin - ergometrine - carboprost - tranexamic acid Surgical - intrauterine balloon tamponade - B-lynch suture - uterine artery ligation - last resort: hysterectomy
41
Secondary postpartum haemorrhage
bleeding occurs from 24 hours to 12 weeks postpartum Likely cause - retained products of conception or infection Investigation - US - Endocervical and high vaginal swabs Management - surgical evacuation of retained products of conception - antibiotics for infection
42
shoulder dystocia
anterior shoulder of baby becomes stuck behind pubic symphysis of the pelvic, after head has been delivered
43
Management of shoulder dystocia
1st: McRobert's manoeuvre Rubin's manoeuvre Wood's screw manoeuvre Zavanelli manoeuvre
44
uterine inversion
funds of uterus drops down through uterine cavity nd cervix, turning the uterus inside out. Very rare occurence Life-threatening obstetric emergency
45
Incomplete vs complete uterine inversion
Incomplete -fundus descends inside uterus or vagina, but not as far as introitus Complete uterine inversion -involves uterus descending through vagina to introitus
46
management of uterus inversion
Johnson manoeuvre Hydrostatis methods Surgery -laparotomy
47
uterine rupture
complication of labour. Muscle layer of uterus (myometrium) ruptures Obstetric emergency very rare to occur in nulliparous
48
incomplete vs complete uterine rupture
incomplete/ uterine dehiscence -uterine serosa (perimetrium) surrounding uterus remains intact Complete rupture -serosa ruptures along with myometrium, and the contents of the uterus are released into peritoneal cavity
49
uterine rupture presentation
``` abdo pain vaginal bleeding ceasing of uterine contraction hypotension tachycardia ``` collapse
50
uterine rupture management
resuscitation and transfusion Emergency c-section
51
maternal sepsis main aetiology
chorioamnionitis | UTI
52
chorioamnionitis
infection of chorioamniotic membranes and amniotic fluid | Leading cause of maternal sepsis and notable cause of maternal death
53
Presentation
fever, tachycardia, raised RR, reduced O2 sats, low BP, altered consciousness, reduced urine output, raised WCC Evidence of foetal compromise on CTG Chorioaminonitis - abdo pain - uterine tenderness - vaginal discharge UTI - dysuria - urinary frequency - suprapubic pain or discomfort - renal angle pain (pyelonephritis) - vomiting (pyelonephritis)
54
investigations of maternal sepsis
Blood test - FBC - U&E - LFTs - CRP - Clotting - Blood cultures - Blood gas (lactate, pH and glucose) Additional - urine dipstick and culture - high vaginal swab - throat swab - sputum culture - wound swab - lumbar puncture for meningitis or encephalitis
55
Sepsis 6
three tests - blood lactate level - blood cultures - urine output three treatments - O2 - empirical broad spectrum ABx - IV fluids
56
antibiotics for maternal sepsis
Co-amoxiclav + metronidazole Severe: Piperacillin/ Tazobactam + Clindamycin Shock: Piperacillin/ Tazobactam + Clindamycin + Gentamicin Penicillin allergic: Clindamycin + Gentamicin

3- Reproduction (15 decks)

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