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Labour & Delivery Flashcards

(55 cards)

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1
Q

When does labour & delivery normally occur

A

37 - 42 weeks

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2
Q

What happens during the 1st stage of labour

A

Cervical dilation up to 10cm
Effacement
Contractions

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3
Q

3 phases of the 1st stage of labour

A

Latent phase - Up to 3cm dilation, 0.5cm per hour, Irregular contractions
Active phase - 3cm to 7cm dilation, 1cm per hour, Regular contractions
Transition phase - 7cm to 10cm dilation, 1cm, strong regular contractions

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4
Q

Signs of labour

A

Show
Rupture of membranes
Regular painful contractions
Dilating cervix

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5
Q

Prophylaxis of preterm labour

A

Vaginal progesterone
Cervical cerclage

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6
Q

Premature rupture of membranes diagnosis

A

Speculum exam - Pooling of amniotic fluid in vagina
Fluid tests - IGFBP-1, PAMG-1

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7
Q

Management of premature rupture of membranes

A

Prophylactic erythromycin (prevent chorioamnionitis)
Induction of labour at 34 weeks

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8
Q

Management of preterm labour

A

Fetal monitoring
Tocolysis with nifedipine
Maternal corticosteroids if before 35 weeks
IV magnesium sulphate if before 34 weeks
Delayed cord clamping

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9
Q

What corticosteroid is used in preterm labour

A

IM betamethasone

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10
Q

Indications for induction of labour

A

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death

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11
Q

What scoring system determines whether to induce labour

A

Bishop Score

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12
Q

What factors make up the Bishop score

A

Fetal station
Cervical position
Cervical dilatation
Cervical effacement
Cervical consistency

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13
Q

Options for induction of labour

A

Membrane sweep - from 40 weeks
Vaginal prostaglandin E2
Cervical ripening balloon - previous c section, failed prostaglandins
Oxytocin infusion

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14
Q

Criteria for uterine hyperstimulation

A

Contractions lasting longer than 2 minutes
More than 5 contractions in 10 minutes

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15
Q

Management of uterine hyperstimulation

A

Removing vaginal prostaglandins
Halting oxytocin
Tocolysis with terbutaline

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16
Q

What are oxytocin infusions used for

A

Induce labour
Progress labour
Improve frequency & strength of uterine contractions
Prevent/treat postpartum haemorrhage

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17
Q

What is ergometrine used for

A

Delivery of the placenta
Reduce & treat postpartum haemorrhage during 3rd stage of labour

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18
Q

What is carboprost used for

A

To treat postpartum haemorrhage when ergometrine & oxytocin have been inadequate
Caution in asthma

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19
Q

When is the 1st stage of labour considered delayed

A

<2cm dilatation in 4hrs
Slowing of progress in multiparous women

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20
Q

What is the 2nd stage of labour

A

10cm cervical dilatation to delivery of the baby

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21
Q

When is the 2nd stage of labour considered delayed

A

Active stage lasting:
-2 hrs in nulliparous
-1 hr in multiparous

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22
Q

Types of fetal lie

A

Longitudinal lie
Transverse lie
Oblique lie

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23
Q

What is the 3rd stage of labour

Study These Flashcards
A

Delivery of the baby to delivery of the placenta

24
Q

When is the 3rd stage of labour considered delayed

Study These Flashcards
A

More than 30 minutes with active management
More than 60 minutes with physiological management

25
Management of failure to progress
Artificial rupture of membranes Oxytocin Instrumental delivery Caesarean section
26
Non-medical options for discomfort during labour
Relaxed environment Changing position Controlled breathing Water birth TENS machine
27
Pain management options during labour
Paracetamol Codeine Entonox IM Pethidine Remifentanil Epidural - Bupivacaine + fentanyl
28
Adverse effects of epidural
Headache after insertion Hypotension Motor weakness in the legs Nerve damage Prolonged 2nd stage Increased probability of instrumental delivery
29
Most significant risk in umbilical cord prolapse
Fetal hypoxia
30
Management of umbilical cord prolapse
Emergency C section Keep cord warm & wet DO NOT push cord back Lie in left lateral position Tocolytics whilst waiting for theatre
31
What is shoulder dystocia
Anterior shoulder of baby gets stuck behind the pubic symphysis after delivery of the head
32
Characteristic sign of shoulder dystocia
Turtle-neck sign
33
Management of shoulder dystocia
Seek senior help including anaesthetist & paediatrician Episiotomy McRoberts manoeuvre Pressure to anterior shoulder by pressing on suprapubic region
34
Complications of shoulder dystocia
Fetal hypoxia Brachial plexus injury Erb's palsy Perineal tears Postpartum haemorrhage
35
Indications for instrumental delivery
Failure to progress Fetal distress Maternal exhaustion To control the head
36
Risks of instrumental delivery
Postpartum haemorrhage Episiotomy Perineal tears Injury to anal sphincter Incontinence Injury to obturator or femoral nerve
37
Risks of instrumental delivery to baby
Cephalohaematoma (ventouse) Facial nerve palsy (forceps) Subgaleal haemorrhage Intracranial haemorrhage Skull fracture Spinal cord injury
38
Risk factors for perineal tears
First birth Large babies Shoulder dystocia Asian ethnicity Occipito-posterior position Instrumental deliveries
39
1st degree perineal tears
Injury limited to frenulum of labia minora & superficial skin
40
2nd degree perineal tear
Includes perineal muscles but not the anal sphincter
41
3rd degree perineal tears
3a - <50% of external anal sphincter 3b - >50% of external anal sphincter 3c - affects both internal & external anal sphincters
42
4th degree perineal tear
Includes rectal mucosa
43
Complications of perineal tears
Pain Infection Bleeding Wound dehiscence Urinary incontinence Anal incontinence Fistula between vagina & bowel Sexual dysfunction Psychological consequences
44
Steps in active management of 3rd stage
IM oxytocin after delivery Cord clamped & cut within 5 mins Controlled cord traction during contraction Aim to deliver in one piece
45
What is classified as postpartum haemorrhage
500ml loss after vaginal delivery 1000ml loss after C section
46
Causes of postpartum haemorrhage
Uterine atony Trauma Retained placenta Bleeding disorders
47
Risk factors for postpartum haemorrhage
Previous PPH Multiple pregnancy Obesity Large baby Failure to progress in 2nd stage Prolonged 3rd stage Pre-eclampsia Placenta praevia Placenta accreta Retained placenta Instrumental delivery
48
Stopping bleeding during postpartum haemorrhage
Rubbing the uterus Catheterisation Oxytocin Ergometrine Carboprost Tranexamic acid Intrauterine balloon tamponade Uterine artery ligation Hysterectomy
49
What causes secondary postpartum haemorrhage
Retained products of conception Infection
50
Key causes of maternal sepsis
Chorioamnionitis UTI
51
Risk factors for amniotic fluid embolism
Increasing maternal age Induction of labour C section Multiple pregnancy
52
Presentation of amniotic fluid embolism
SOB Hypoxia Hypotension Coagulopathy Haemorrhage Tachycardia Confusion Seizures Cardiac arrest
53
Risk factors for uterine rupture
Previous C section VBAC Previous uterine surgery Increased BMI High parity Increased age Induction of labour Use of oxytocin
54
Presentation of uterine rupture
Abnormal CTG Abdominal pain Vaginal bleeding Ceasing of uterine contractions Hypotension Tachycardia Collapse
55
Management of uterine rupture
Emergency C section Repair uterus/hysterectomy

OBGYN (5 decks)

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