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Obs and Gynae > Labour and Delivery > Flashcards

Labour and Delivery Flashcards

(108 cards)

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1
Q

Define the first stage of labour

A

Cervical dilatation to 10cm

Cervical effacement i.e. thinning

“show” i.e. mucus plug falls out

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2
Q

At what rate does cervical dilatation occur during the latent phase of FSL?

A

0.5cm per hour

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3
Q

At what rate does cervical dilatation occur during the active phase of FSL?

A

1cm per hour

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4
Q

At what rate does cervical dilatation occur during the transition phase of FSL?

A

1cm per hour

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5
Q

Define Braxton-Hicks contractions

A

Occasional irregular contractions of the uterus

Felt in 2nd/3rd trimester

Do not progress or become regular

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6
Q

What four things demonstrate the onset of labour?

A

Show

Rupture of membranes

Painful regular contractions

Dilating cervix

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7
Q

At what point of cervical dilatation is first stage of labour established?

A

from 4cm onwards

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8
Q

Define prematurity

A

<37 weeks gestation

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9
Q

Name two methods of prophylaxis of preterm labour

A

Vaginal progesterone (if cervical length <25mm on TV US at 16-24 wks gestation)

Cervical cerclage
- Stitch in the cervix to add support

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10
Q

Define preterm prelabour rupture of membranes

A

Amniotic sac ruptures

Before the onset of labour

In a preterm pregnancy (<37 weeks gestation)

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11
Q

What is the management of P-PROM?

A

Prophylactic antibiotics to prevent chorioamnionitis

Induction of labour from 34 wks onwards

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12
Q

What is tocolysis in premature labour?

A

Medications to stop uterine contractions

e.g. Nifedipine

24-33+6 wks gestation

Only useful for 48 hours!

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13
Q

What medication is given to reduce RDS in neonates born prematurely?

A

Corticosteroids

Often two doses of IM betamethasone, 24 hours apart

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14
Q

When are corticosteroids given to prevent RDS in neonates?

A

< 36 weeks gestation

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15
Q

What medication is given IV to reduce the risk of cerebral palsy in infants born <34 weeks gestation?

A

IV magnesium sulphate

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16
Q

At what gestation is induction of labour offered?

A

41-42 weeks gestation

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17
Q

What scoring system is used to determine if labour should be induced?

A

Bishops score

> 8

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18
Q

Define membrane sweep

A

Induction of labour

Insert finger into the cervix to stimulate cervix and begin process of labour

If successful, can induce labour within 48 hours

Used from 40 weeks gestation

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19
Q

How does vaginal prostaglandin E2 work for IOL?

A

Gel/tablet/pessary PV

Slowly releases local prostaglandins over 24 hour

Stimulates cervix and uterus to cause onset of labour

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20
Q

How does artificial rupture of membranes work for IOL?

A

Oxytocin infusion

Often after vaginal prostaglandins have been used

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21
Q

Name two means for monitoring during IOL?

A

Cardiotocography to assess fetal heart rate and uterine contractions before/during labour

Bishop score to monitor progress

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22
Q

Define uterine hyperstimulation

A

Main complication of IOL with vaginal prostaglandins

Causes prolonged and frequent uterine contractions = fetal distress and compromise

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23
Q

What is major risk of uterine hyperstimulation?

A

Uterine rupture

Fetal compromise w/hypoxia and acidosis

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24
Q

What are the two management options for uterine hyperstimulation?

A

Remove PV prostaglandins or stop oxytocin infusion

Tocolysis with terbutaline

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25
What is electronic fetal monitoring? What does it measure?
Cardiotocophraphy Fetal heart rate and uterine contractions
26
Define accelerations in relation to CTG
Periods of fetal HR spikes
27
Define deceleration in relation to CTG
Periods of fetal HR drops
28
What is "reassuring" for baseline rate and variability?
Baseline rate 110-160 | Variability 5-25
29
Define early deceleration
Gradual reduction in HR Corresponds w/uterine contractions Not pathological
30
Define late decelerations
Gradual fall in HR Start after uterine contraction Lowest point of deceleration occurs after the peak of the contraction Due to hypoxia e.g. excessive uterine contractions, maternal hypertension or maternal hypoxia
31
Define variable declerations
Abrupt deceleration Can be unrelated to uterine contractions Fall >15bpm from baseline Due to intermittent compression of umbilical cord = fetal hypoxia
32
Define prolonged deceleratins
Last 2-10 minutes w/drop >15 bpm from baseline | Abnormal and concerning
33
What is the baseline rate for non-reassuring?
100-109 or 161-180
34
What is variability for non-reassuring?
< 5 for 30-50 mins or >25 for 15-25 mins
35
What is abnormal baseline rate?
<100 or >180
36
What is abnormal variability?
<5 for over 50mins or >25 over 25 mins
37
Define suspicious CTG
single non-reassuring abnormal feature
38
Define pathological CTG
two non-reassuring or single abnormal feature
39
Define need for urgent intervention
acute bradycardia or prolonged deceleration >3 minutes
40
What is the "rule of 3's" for fetal bradycardia?
3 minutes = call for help 6 minutes = move to theatre 9 minutes = prepare for delivery 12 minutes = deliver the baby (in 15 mins!)
41
What is Dr C BRaVADO?
``` Define Risk Contractions Baseline Rate Variability Accelerations Decelerations Overall impressions ```
42
How does oxytocin work?
Secreted by posterior pituitary gland Ripens cervix Uterine contractions
43
Atosiban
Oxytocin receptor antagonist for tocolysis
44
Ergometrine
Stimulates smooth muscle contraction Third stage of labour, tx PPH
45
Misoprostol
Prostaglandin analogue | Medical management of miscarriage
46
Mifepristone
Anti-progestogen | Blocks progesterone action
47
Nifedipine
Calcium channel blocker Reduce BP in hypertension and pre-eclampsia Tocolysis in premature labour
48
Terbutaline
Beta 2 agonist Tocolysis in uterine hyperstimulation
49
Tranexamic Acid
Antifibrinolytic Prevents fibrinogen to plasmin Postpartum hemorrhage
50
First Stage of Labour Phases?
Latent i.e. 0-3cm dilation, 0.5cm per hour Active i.e. 3-7cm, 1cm per hour Transition i.e. 7-10cm, 1cm per hour
51
What is the criteria for delayed first stage of labour?
<2cm of cervical dilatation in 4 hours Slowing of progress in multiparous women
52
Partogram
Monitor progress in first stage of labour
53
Second stage of labour?
10cm dilatation to delivery of baby
54
Criteria for delay in 2nd stage of labour
2 hours in nulliparous 1 hour in multiparous
55
What three things determine the second stage of labour?
Power Passenger Passage
56
Define 3rd stage of labour
Delivery of baby to delivery of placenta
57
Define delay in 3rd stage of labour
>30 minutes with active management >60 minutes with physiological management
58
What is involved in active management of third stage of labour?
IM oxytocin | Controlled cord traction
59
What is the aim for number of contractions in those medically managed in failure to progress?
4-5 contractions per 10 minutes
60
Define Entonox
50% nitrous oxide | 50% oxygen
61
Name the drug used in PCA for delivery
Remifentanil
62
Management of umbilical cord prolapse
Emergency caesarean section
63
Define shoulder dystocia
Anterior shoulder of baby becomes stuck behind the pubic symphasis After the head has been delivered Obstetric emergency Often caused by macrosomia secondary to gestational diabetes
64
Presentation of shoulder dystocia
Difficulty delivering face and head Obstruction in delivering the shoulders after delivery of the head
65
Episiotomy
Enlarges vaginal opening Reduces risk of perineal tears
66
McRoberts Manoeuvre
Bring knees up to abdomen Posterior pelvic tilt Lifts pubic symphysis out the way
67
Zavanelli Manoeuvre
Push babys head back into vagina Allow for emergency c section delivery
68
Complications of should dystocia
Fetal hypoxia Brachial plexus injury and Erb's palsy Perineal tears Postpartum haemorrhage
69
Name 4 indications for instrumental delivery
Failure to progress Fetal distress Maternal exhaustion Control of the head in various fetal positions
70
What 2 key risks are there to baby in instrumental delivery?
Cephalohaematoma (with a ventouse) Facial nerve palsy (with forceps)
71
Define ceaphalohaematoma
Collection of blood between the skull and periosteum Complication of ventouse delivery
72
Name two nerve injuries that may develop due to instrumental delivery in mum?
Femoral nerve = weakness of knee extension, loss of patella reflex and numbness Obturator nerve = weakness in hip adduction/rotation
73
Define first degree perineal tear
Limited to frenulum of labia minora
74
Define second degree perineal tear
Perineal muscles Not anal sphincter
75
Define third degree perineal tear
Anal sphincter Not rectal mucosa
76
Define fourth degree perineal tear
involves rectal mucosa
77
Management of second degree tears
Sutures
78
Management of 3rd/4th degree tears
Surgical repair in theatre
79
Name four short term complications of perineal tears
Pain Infection Bleeding Wound dehiscence or breakdown
80
Name three long term complications of perineal tears
Urinary incontinence Anal incontinence Sexual dysfunction
81
Define episiotomy
45 degree cut in the perineum Mediolateral to avoid anal sphincter Sutured after delivery
82
Define physiological management of third stage of labour
Placenta delivered by maternal effort Without medications or cord traction
83
Define active management of third stage of labour
HCP involved in delivery of placenta IM oxytocin = uterine contraction Cord traction = guide placenta out Routinely offered to all women to reduce risk of PPH
84
Name two indications of active management of third stage of labour
Haemorrhage >60 minutes delay in placental delivery
85
Define PPH
Postpartum haemorrhage Bleeding after delivery of baby and placenta Commonest cause of significant obstetric haemorrhage 500ml after vaginal delivery 1000ml after caesarean section
86
Define primary and secondary PPH
Primary = within 24 hours Secondary = from 24hrs - 12wks postpartum
87
Name the four "T's" causing postpartum haemorrhage
Tone - uterine atony Trauma e.g. perineal tear Tissue e.g. retained placenta Thrombin e.g. bleeding disorder
88
Name three risk factors of postpartum haemorrhage
Previous PPH Multiple pregnancies Obesity Large baby
89
Name three methods to reduce risk/consequences of postpartum haemorrhage
Treating anaemia in antenatal period Give birth with an empty bladder (full bladder reduces uterine contractions) Active management of 3rd stage IV tranexamic acid during c section in higher-risk pts
90
Outline management of PPH
``` ABCDE approach Lie mum flat, keep her warm 2 large bore cannulas Bloods e.g. FBC, U&Es, clotting screen Group and cross match four units Warmed IV fluids/blood resuscitation as required Oxygen ```
91
Outline mechanical methods for PPH
Rubbing the uterus through abdomen = stimulate uterine contraction Catheterisation = empty bladder
92
Outline Medical management of PPH
Oxytocin infusion Ergometrine = stimulate smooth muscle contraction Carbopost = prostaglandin analogue, stimulates uterine contraction (caution in asthma) Tranexamic acid = antifibrinolytic
93
Outline surgical management of PPH
Intrauterine balloon tamponade B-lynch suture Uterine artery ligation Hysterectomy
94
Name two causes of secondary PPH
Retained products of conception Infection e.g. endometritis
95
Define caesarean section
Surgical operation to deliver the baby via incision in the abdomen and uterus Transverse lower uterine segment incision
96
Name four risks of caesarean section
Infection - give prophylactic antibiotics during procedure PPH - given oxytocin during VTE - given LMWH e.g. enoxaparin Pain
97
Name two causes of shock in pregnancy
Chorioamnionitis UTI
98
Define MOEWS
Maternity Early Obstetric Warning System
99
Name three signs of chorioamnionitis
Abdominal pain Uterine Tenderness Vaginal discharge
100
What is involved in sepsis six?
Take three 1. Blood lactate 2. Blood cultures 3. Urine output Give three 1. Oxygen 2. Antibiotics 3. IV fluids
101
Define amniotic fluid embolism
Rare Amniotic fluid passes into the mothers blood Often around labour and delivery Amniotic fluid contacts fetal tissue which causes an immune response
102
Name two risk factors for amniotic fluid embolism
Increased maternal age Induction of labour
103
Overview of symptoms of amniotic fluid embolism
Similar to sepsis, pulmonary embolism or anaphylaxis SOB/hypoxia/hypotension etc
104
Management of amniotic fluid embolism
Supportive A-E approach ITU care
105
Main risk factor for uterine rupture
Previous C section
106
Key features of uterine rupture
Abdominal pain PV bleeding Ceasing of uterine contractions Hypotension/collapse
107
Management of uterine rupture
Obstetric emergency Resuscitation and transfusion Emergency c section Stop bleeding Hysterectomy
108
Define Johnson manoeuvre
Reversal of uterine inversion Use a hand to push fundus back into abdomen and correct position Often involves inserting the whole forearm into the vagina

Obs and Gynae (5 decks)

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