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Lecture 11 Normal Labour Abnormal Labour and Postnatal Period Flashcards

1
Q

What period of gestation does normal labour occur

A

37-42 weeks gestation

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2
Q

Name the 4 key changes at the beginning of labour

A

Cervix softens
Myometrial tone changes
Progesterone decreases
Oxytocin and Prostaglandin increase to initiate labour

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3
Q

Name the 3 phases of the first stage of labour

A

Latent- dilatation up to 4cm
Active- 4-10cm
Transition- 8-10cm

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4
Q

What happens during the second stage of labour

A

Passive and Active stage

Ful dilatation to birth

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5
Q

What happens during the third stage of labour

A

Birth of baby

Expulsion of the placenta

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6
Q

Name the 3 foetal lies

A

Cephalic
Breech
Transverse lie

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7
Q

Name the 5 Foetal presentation

A 
Face
Brow
Vertex
Breech
Shoulder
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8
Q

Name the 3 Feotal Positions

A

Occipitoposterior
Occipitotransverse
Occipitoanterior

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9
Q

What is a normal foetal heart rate?

A

110-160bpm

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10
Q

Name drug free labour analgesia

A

Birthing ball
Birthing pool
Hypnobirthing
Aromatherapy

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11
Q

Name simple drug therapies for labour analgesia

A

Entonox (Gas and Air)

Diamorphine

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12
Q

Name the benefits of Entonox

A

Takes 30 seconds to work
Safe
Mother in control
Can be used with other pain relief techniques

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13
Q

Name disadvantages of Entonox

A

Wears off quickly
Dizzy, dry mouth, sick
Won’t take pain away

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14
Q

Name benefits of diamorphine

A

Injection at top of the leg
Last 4 hours
Strong pain relief and relaxation

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15
Q

Name disadvantages of diamorphine

A

Makes you feel sick, sleep and slow down breathing. Has same effect on baby

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16
Q

Name advanced drug techniques for labour analgesia

A

Remifentanil PCA

Epidural

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17
Q

What are the benefits of Remifentanil PCA

A

Morphine like pain relief
Mother in control
Small amount given as a pump when button is pressed
Works quickly

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18
Q

What are the disadvantages of Remifentanil PCA

A 
Wears off quickly
Can slow down breathing
Can make you feel drowsy
Cannot start this drug if you've have diamorphine after 4 hours
Drowsy, sick and itchy
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19
Q

What are the benefits of epidural

A 
Can self-administer
20 minutes to work
Can still use gas and air
Does not affect baby
You are in control
Can be topped up with stronger medicine
Does not slow down cervix dilatation
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20
Q

What are the disadvantages of an epidural

A 
Can slow pushing phase
Risk of forceps/suction cups
Drop in blood pressure
Itching, fever
Sore back
Headache
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21
Q

Name the complications of an epidural

A 
Nerve damage
Epidural abscess
Meningitis
Haematoma
Unconsciousness
Severe injury
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22
Q

Name potential indications for the induction

A 
Hypertensive disorders
Maternal diabetes
Prolonged pregnancy
Twin pregnancy
Prelabour rupture of membranes 
Foetal growth restriction or macrosomia
Previous stillbirth or in utero death
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23
Q

Name contraindications for induction of labour

A 
Malpresentation
Placenta praaevia 
Prolapsed umbilical cord
Foetal distress
Pelvic tumour
Previous C-section
Maternal asthma
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24
Q

What is a bishop score used to assess

A

Cervix position, consistency, dilatation

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25
What does a low bishop score mean
Not ready for labour
26
What does a high bishop score mean
Ready for labour
27
What medications can be done to induce labour
Topical prostaglandin analogues (misoprostol) | IV synthetic oxytocin
28
What does Oxytocin causes
Initiates uterine contractions
29
Describe the process of induction of labour
Once cervix has dilated and effaced an amniotomy is performed IV oxytocin id administered(4-5 contractions in 10 minutes)
30
What Bishop score is considered favourable for amniotomy
7+
31
Name Intrapartum complications
Inadequate uterine activity Cephalopelvic (powers) disproportion, obstruction (passages) Malposition (passenger)
32
What are the main causes of foetal distress
Hypoxia, infection, cord prolapse, placental abruption and vasa praaevia
33
Name 4 types of foetal monitoring
Intermittent auscultation of the foetal heart CTG Foetal blood sampling Foetal ECG
34
When is foetal blood sampling carried
Used when abnormal CTG
35
What can you measure from foetal blood sampling
pH (hypoxaemia) and base excess, lactic acid
36
Name third stage complications
Retained placenta Pst-partum haemorrhage Tears
37
What are the 4 causes of Postpartum Haemorhage
Tone Trauma Tissue Thrombin
38
Describe a 3rd degree tear
Involving anal sphincter complex
39
Describe a 4th degree tear
Involving rectal mucosa
40
Name complications with breast feeding
Mastitis Blocked milk ducts Difficulty feeding/baby latching Cracked nipples
41
Name 5 key postnatal conditions
``` Post-partum haemorrhage Venous thromboembolism Sepsis Psychiatric disorders Pre-eclampsia ```
42
What is primary postpartum haemorrhage
Blood loss >500ml within 24 hours | Tone, trauma, retained tissue, thrombin
43
What is secondary postpartum haemorrhage
Blood loss >50ml from 24 hours post party to 6 weeks
44
What is the presentation of thromboembolic disease
Unilateral leg swelling SOB or chest pain Unexplained tachycardia
45
How do you investigate thromboembolic disease
ECG Leg dopplers CXR +/- VQ scan
46
How do you treat thromboembolic disease
Low molecular weight heparin | Warfarin is teratogenic (can be used when breast feeding)
47
Not breastfeeding increases what risks for babies
``` Gastroenteritis Respiratory infections Allergies Obesity Type I and II diabetes SIDS ```
48
Not breastfeeding increases what risks for mothers
Breast cancer Ovarian cancer Hip fractures Heart disease
49
What is the WHO/Unicef UK baby friendly initiative
Requires that all baby friendly accredited services adhere to the international code of marketing of breastmilk substitutes (the code)
50
Name the 3 stages of lactation
1. Breast development and colostrum production 2. Onset of copious milk secretion 3. Maintenance of milk production
51
What happens to the oestrogen and progesterone levels after birth
They drop
52
What is role of Prolactin
Responsible for milk production (lactocyte production) Responsive to touch and stimulation Levels higher at night
53
What is the role of oxytocin
Responsible for milk delivery Acts on muscle cells in pulsatile action Levels higher when baby is near
54
What is the importance of skin to skin contact
Triggers lactation and mothering hormones Regulates tem, HR and breathing Colonises baby with microbes from mother Stimulates feeding behaviour Reduces stress hormones in mother and baby
55
What is Shoulder Dystocia
Occurs when the anterior foetal shoulder becomes impacted behind the maternal pubic symphysis after delivery of the foetal head
56
What is the management of Shoulder Dystocia
* H – Call for Help * E – Evaluate for Episiotomy * L – Legs (McRoberts Position) * P – Suprapubic Pressure * E – Enter Manouvers (Internal Rotation) * R – Remove the Posterior Arm * R – Roll the Patient (Onto all Fours)
57
Name thrombin related causes of PPH
Pre-eclampsia Placental abruption Pyrexia in labour Bleeding disorders
58
Name tissue related causes PPH
Retained placenta Placenta accreta Retained POC
59
Name tone related causes of PPH
Placenta praaevia Over distention of uterus Uterine relaxants Previous PPH
60
Name trauma related causes PPH
C-section Epiostomy Macrosomia
61
Name other causes of PPH
``` Asian ethnicity Anaemia Induction BMI>35 Prolonged labour Age ```
62
What is the medical management of PPH
``` ABCDE Empty bladder - Oxytocin 5iu slow iv injection - Ergometrine 0.5mg slow iv injection (not if high BP)- cause heavy contractions - Oxytocin infusion - Tranexamic acid 1g IV - controls bleeding - Carboprost 0.25mg im (max 8 doses - Misoprostol 800 micrograms) ```
63
What is the surgical management of PPH
``` Intrauterine balloon tamponade Interventional radiology B-lynch suture Hysterectomy Fluid replacement +/- blood products ```
64
What is the management for a cord prolapse
Replace cord in vagina Catheterise and fill bladder Encourage mother to adopt knee chest or left lateral position with raised hip Arrange for c-section

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