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Women's health > Labour and delivery > Flashcards

Labour and delivery Flashcards

1
Q

Labour : Shoulder Dystocia : Definition

A

Problem in delivery due to impaction of the anterior fatal shoulder on the mother’s pubic symphysis

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2
Q

Labour : Shoulder Dystocia : Management

A

First line :
H - call for help - medical emergency
E - evaluate for episiology
L -egs } Mc Robert’s manoeuvre of hip flexion and abduction
P - suprapubic pressure
Second line
Enter manourvre : Internal rotation of shoulder
Release posterior arm

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3
Q

Labour : Shoulder Dystocia : Key risk factors

A
  • Fetal macrosomia
  • Maternal Obesity / DM
  • Prolonged labour
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4
Q

Labour : Shoulder Dystocia : Complications : Maternal + Fetal

A
  1. Maternal
    • postpartum haemorrhage
    • perineal tears
  2. Fetal
    • brachial plexus injury
    • neonatal death
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5
Q

Labour : Stage 1 : Definition

A

Contractions
Cervical dilation 0-10cm

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6
Q

Labour : Stage 1 : 3 phases

A
  1. Latent phase
    – 0 to 3cm dilation of the cervix.
    -0.5cm per hour
  2. Active phase
    -3cm to 7cm dilation of the cervix.
    1cm per hour
  3. Transition phase
    7cm to 10cm dilation of the cervix.
    1cm per hour
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7
Q

Labour : Stage 1 : Delayed definition

A
  • Less than 2cm of cervical dilatation in 4 hours
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8
Q

Labour : Stage 2 definition

A

10cm dilatation of the cervix to delivery of the baby

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9
Q

Labour : Stage 2 : Factors involved

A

Power* : strength of uterine contraction
Passenger: Size/altitude/Lie/Presentation of foetus
Passage : Shape of pelvis

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10
Q

Labour : Transverse lie

A
  • Transverse lie – the fetus is straight side to side
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11
Q

Labour : Oblique lie

A
  • Oblique lie – the fetus is at an angle
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12
Q

Labour : Cephalic presentation

A
  • Cephalic presentation – the head is first
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13
Q

Labour : Shoulder presentation

A
  • Shoulder presentation – the shoulder is first
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14
Q

Labour : Breech presentation

A
  • Breech presentation – the legs are first. This can be:
    • Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
    • *Frank breech *– with hips flexed and knees extended, bottom first
    • *Footling breech *– with a foot hanging through the cervix
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15
Q

Labour : Stage 2 : Delayed definition

A

Active second stage of pushing lasts over:
* 2 hours in a nulliparous woman
* 1 hour in a multiparous woman

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16
Q

Labour : Stage 3 : Definition

A

The third stage of labour is from delivery of the baby to delivery of the placenta

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17
Q

Labour : Stage 3 : Delay definition

A
  • More than 30 minutes with active management
  • More than 60 minutes with physiological management
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18
Q

Labour : Shoulder Dystocia : Definition

A

Problem in delivery due to impaction of the anterior fatal shoulder on the mother’s pubic symphysis

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19
Q

Labour : Shoulder Dystocia : Management

A

First line :
H - call for help - medical emergency
E - evaluate for episiology
L -egs } Mc Robert’s manoeuvre of hip flexion and abduction
P - suprapubic pressure
Second line
Enter manourvre : Internal rotation of shoulder
Release posterior arm

How well did you know this?
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20
Q

Labour : Shoulder Dystocia : Key risk factors

A

Fetal macrosomia
Maternal Obesity / DM
Prolonged labour

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21
Q

Labour : Shoulder Dystocia : Complications

A
  1. maternal
    • postpartum haemorrhage
    • perineal tears
  2. fetal
    • brachial plexus injury
    • neonatal death
22
Q

Oligohydramnios : Definition

A

Reduced amniotic fluid < 500ml at 32-36 weeks

23
Q

Oligohydramnios : Causes

A
  • premature rupture of membranes
  • Potter sequence
    • bilateral renal agenesis + pulmonary hypoplasia
  • intrauterine growth restriction
  • post-term gestation
  • pre-eclampsia
24
Q

Induction of labour : Definition

A

Induction of labour describes a process where labour is started artificially

25
Q

Induction of labour : Indications

A
  1. Prolonged pregnancy e.g. 1-2 weeks after the estimated date of delivery
  2. Prelabour premature rupture of the membranes where labour does not start
  3. Maternal medical problems
    • diabetic mother > 38 weeks
    • pre-eclampsia
    • obstetric cholestasis
  4. Intrauterine fetal death
26
Q

Induction of labour : Bishop’s score

A
      1. Cervical position : Posterior/Intermediate/Anterior
        Cervical consistency: Firm/Intermediate/Soft
        Cervical effacement:
        0-30%/40-50%/60-70%/80%
        Cervical dilation
        • <1 cm/1-2 cm/3-4 cm/>5 cm
          Fetal station:
          -3/-2/-1, 0/+1,+2
  • < 5 : Requires induction
  • > 8 : Spontaneous labour is likely
27
Q

Induction of labour : Mx of Bishop score < 6

A
  1. Membrane sweep : separtion of the chorionic villi with vaginal exam.
  2. Vaginal prostaglandin or Oral Misoprostol
28
Q

Induction of labour : Mx of Bishop score >6

A
  1. Amniotomy : artificially rupture of the amniotic sac
  2. IV Oxytocin infusion
29
Q

Induction of labour : Complication

A
  1. Uterine hyperstimulation : very frequent contraction
    -Limit blood flow to foetus and cause hypoxymaeia
    Mx : Remove prostaglandins or stop IV oxytocin infusion\
30
Q

Prematurity : Definition

A

< 37 weeks of gestation
Non viable < 23 weeks

31
Q

Preterm labour : Proxylaxis

A
  1. Vaginal progesterone
  2. Cervical cerclage : stitch the cervix to keep it closed
32
Q

Preterm Prelabour Rupture of membranes : Definition

A
  • Theamniotic sac ruptures, releasing amniotic fluid
  • Before the onset of labour
    and
  • In a preterm pregnancy (under 37 weeks gestation)
33
Q

Preterm Prelabour Rupture of membranes : Diagnosis

A
  1. Speculum examination : revealing pooling of amniotic fluid in the vagina.
  2. Insulin-like growth factor-binding protein-1(IGFBP-1) is a protein present in high concentrations in amniotic fluid
    * which can be tested on vaginal fluid if there is doubt about rupture of membranes
34
Q

Preterm Prelabour Rupture of membranes : Management

A
  1. Prophylactic antibiotics
    * given to prevent the development of chorioamnionitis
    * Erythromycin 250mg four times daily for ten days, or until labour is established if within ten days.
  2. Induction of labour may be offered from 34 weeks to initiate the onset of labour.
35
Q

Preterm Labour with Intact Membranes : Definition

A
  1. Preterm labour with intact membranes involves regular painful contraction and cervical dilatation
    * Without rupture of the amniotic sac.
36
Q

Preterm Labour with Intact Membranes : Diagnosis

A

< 30 weeks gestation: Speculum and clinical assessment of cervical dilatation

>30 weeks gestation:
1. transvaginal ultrasound can be used to assess the cervical length.
* cervical length on ultrasound < 15mm, management of preterm labour can be offered

  • Fetal fibronectin : alternative to US
    Fetal fibronectin is the “glue” between the chorion and the uterus, and is found in the vagina during labour
37
Q

Preterm Labour with Intact Membranes : Management

A
  1. Fetal monitoring (CTG or intermittent auscultation)
  2. Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
  3. Maternal corticosteroids: can be offered before 35 weeks gestation to reduce risk of respiratory distress syndrome
  4. IV magnesium sulphate: can be given before 34 weeks gestation, reduces risk of cerebral palsy
  5. Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby at birth
38
Q

Umbilical chord prolapse : definition

A
  1. Umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina
  2. After rupture of the fetal membranes.
  3. There is a significant danger of the presenting part compressing the cord, resulting in fetal hypoxia.
39
Q

Umbilical chord prolapse : Diagnosis

A
  1. CTG : fetal distress
  2. Vaginal / Speculum : shows umbilical chord
40
Q

Umbilical chord prolapse : Management

A
  1. Push up presenting part of foetus to prevent chord compression
  2. Tocolytic medication - to minimise contraction

Definitive management : Emergency C section

41
Q

Breech presentation : Definition

A

baby is positioned feet or buttocks first in the uterus instead of the head-first position, which is the typical and safest presentation for childbirth.

Frank breech - most common presentation

42
Q

Breech presentation : Risk factors

A
  1. Uterine malformation : Fibroids, Placenta Previa
  2. Amniotic fluid : Polyhydramnios or Oligohydramnios
  3. Prematurity
  4. Fetal abnormality
43
Q

Breech presentation : Management

A
  1. <36 weeks : most will turn spontaneously
  2. > 36 weeks : External cephalic version
    * Avoid if major uterine anomaly, ruptured membrane, bleeding, multiple pregnancy
    3 .. Remains breech : C section
44
Q

Breastfeeding : Drug CI

A
  • antibiotics:ciprofloxacin,tetracycline, chloramphenicol,sulphonamides
  • psychiatric drugs:lithium,benzodiazepines
  • aspirin : increases risk of bleeding disorders in newborns due to vitamin K inhibition
  • carbimazole
  • methotrexate
  • sulfonylureas
  • cytotoxic drugs
  • amiodarone : high half
45
Q

Uterine rupture : Risk factors

A
  • RF
  • Previous C section < 18 months
  • Macrosomia
  • High parity

Presents with - sig haemodynamic compromise,

46
Q

Post-date - >40 weeks

A

No sign of labour after 40 weeks
1. Membranę sweep
2. Medical induction of labour at 41-42 weeks via Vaginal prostaglandin pessary

47
Q

Risks of C section

A

DVT, PE, Bleeding
* Injury to bladder or down

48
Q

Neontal infection

A

Conjunctival gonorrhoea - 5 days following delivery

Meconium passed in utero - can be a sign of foetal distress.
Risk of foetal meconium aspiration

49
Q

UK perimortality rate

A

Number of stillbirths and early neonatal deaths <7 days per 1000 live births and still births

50
Q
A
51
Q

NSAID in pregnancy

A

NSAID - avoid in third trimester
Risk of ductus arterioles closing
Oligohydramnios

Women's health (12 decks)

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