Maternity Flashcards
- What does the rupture of membranes represent?
A hole/tear forms in the amniotic sac, can either be spontaneous, most often after active labour has started, or can be ruptured by a doctor/midwife. It is normally a cloudy-white - amber-straw colour and has a sweeter smell or no smell.
Lying down more likely to feel gush than standing because baby’s head acts a plug.
- What are the characteristics of first and second stage of labour?
First: onset of contractions every 2-20mins, 20-60secs, duration to full cervical dilation
Second: full cervical dilation to birth of the baby - primipara 1-2hrs, multipara 15-45mins
- What are considerations for maternity destination?
> 36 weeks and uncomplicated Tx to booked maternity unit/closest
32-36 weeks consult PIPER
<32 weeks Tx to closest of Women’s, Mercy, Women Heidelberg or MMC
*Not to Alfred unless in cardiac arrest <24 weeks gestation with mCPR in progress
- What is the Rx for pre-eclampsia?
- Severe HTN SBP>170 or DBP>110 and pre-eclampsia s&s - consult with PIPER to Mx HTN
- Seizure activity: Mx as per CPG, left lateral tilt, High flow O2
- What are the S+S of pre-ecmlampsia?
- Headache
- Cerebral irritation/agitation
- Visual disturbances (flashing lights, shimmering)
- N/V
- Heartburn
- Hyper-reflexia
- Elevation of 20mmHg above normal BP may be sufficient sign if other Sx present
- What are the main steps to consider for a Normal Birth?
- As head advances encourage mother to push with each contraction, if birthing too fast encourage mother to pant instead
- Gentle pressure to perineum to reduce tear
- Note time of head delivery
- Check for umbilical cord around neck, if loose unwrap, if tight encourage pushing, otherwise clamp and cut cord
- Gentle downwards pressure to deliver anterior shoulder and upward for posterior, note time of birth - if body fails to deliver <60secs after head Mx as shoulder dystocia
- Cord - wait for it to stop pulsating 1-2mins - clamp 10cm from baby and second a further 5cm
- Placenta takes 15-60mins, position sitting/squatting, breast feeding may assist separation - ask mother to push - ease out with see-saw motion, note time of delivery and place into container
- Don’t massage fundus once firm
- What should be done in the setting of imminent breech birth with back not uppermost?
Position mother kneeling on all fours to allow restitution.
- What are key things to remember and encourage for mother during breech birth?
- Encourage mother to push hard with contractions
- Lithotomy position
- HANDS OFF approach - only touch to gently support - main force of birth is maternal effort
- Maintain warmth of body
- Delivery of babies head in Frank position and back uppermost (most common):
- Let baby hang until nape of neck is visible
- Mauriceau-Smellie Veit: non-dominant index and ring finer on shoulders, middle finger on occiput - Flexion of head
- dominant hand under baby to support body - ring and index fingers on cheekbones
- Lift baby straight up in a circle onto mother’s abdomen , allowing head to birth slowly
- What to do when Frank position but back not uppermost?
- Place thumbs on bony sacrum - fingers around thighs
- Rotate between contractions
- Do not squeeze abdo and take care of spine
- Never pull the baby
- What to do when baby is in Frank presentation and arms aren’t birthing spontaenously?
Lovsett’s manoeuvre
- hold baby by sacrum - turn baby 90deg, so shoulder in anterior-posterior
- insert finger into brachial plexus and sweep arm over baby’s chest
- turn 180deg and repeat
- turn 90deg again so back uppermost
- What is the Rx for Antepartum haemorrhage?
Clinical signs of altered perfusion: internal bleeding may greatly exceed visible external bleeding
- Place pt in left lateral tilt position
- Tx to appropriate obstetric hospital with notification
- Less than adequate perfusion - NS 40mL/kg, consult for further or 20mL/kg
- Pain relief
- What is the Rx for Preterm Labour?
Contractions present and birth not imminent (<34wks)
Consult for 50mg GTN patch applied to abdomen, additional one may be applied after an hour if contractions persist
- What is the Mx of Cord Prolapse?
- Birth commencing: instruct mother to push, prepare for resus, cord handling kept to a minimum
- Birth not imminent:
Mother: position semi-prone, hips elevated over towels; High flow O2
Cord: keep warm and moist, use 2 fingers to gently place in vagina, if unsuccessful cover with warm saline packs
Presenting part: if pressure on cord, push presenting part away from cord, maintain pressure
- What is the Hx needed for Cord Prolapse?
- Time membranes ruptured?
- How long has cord been visible?
- Due date?
- Foetal movement felt?
- Onset of labour? Contractions present?
- Foetal presentation?
- PV bleeding?
