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CP2 OBGYN > Mx Labour Part 2 > Flashcards

Mx Labour Part 2 Flashcards

1
Q

How is fetal blood sampling done

A

Amnioscope - tiny amount blood = removed from scalp for pH + BE to be measured

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2
Q

Indicated FBS ((5)

A

Persistent late/variable decelerations on CTG
Persistent fetal tachycardia
Prolonged + persistent early decelerations
Signif meconium stained liquor along w/ any CTG abnorm
Prolonged loss of baseline variability

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3
Q

C/I FBS (3)

A

If risk of infection transmitted from mother
Fetal bleeding diathesis
<34w gestation

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4
Q

FBS - If pH is found to be 7.20-7.25, what should be done

A

Repeat at 30-60 mins

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5
Q

FBS - if pH is found to be <7.2, what should be done

A

Delivery by CSC, ventouse or forceps

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6
Q

FBS - BE value > -8 indicates

A

Metabolic acidosis

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7
Q

What substances can affect FBS results (3)

A

Amniotic fluid
Meconium
Maternal blood

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8
Q

What can the presence of meconium in liquor signify?

A

Signs of fetal distress

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9
Q

Why does meconium staining occur?

A

Stimulation of CNX (parasym) in utero –> foetal gut to contract + anal sphincter to relax

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10
Q

Meconium staining - grade 1

A

Good volume of liquor stained lightly w/ meconium

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11
Q

Meconium staining - grade 2

A

Reasonable volume of liquor w/ heavy suspension of meconium

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12
Q

Meconium staining - grade 3

A

Thick undiluted volume of meconium, pea soup consistency

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13
Q

if meconium is found below the vocal chords, what is this called

A

Meconium aspiration syndrome

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14
Q

What is Meconium aspiration syndrme

A

Neonatal pneumonitis

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15
Q

When is meconium aspiration syndrome likely to be more severe?

A

of assoc w/ acidosis/hypoxia

when meconium = thick

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16
Q

Non-medical pain relief options during labour (6)

A 
Birth attendant 
Maintenance of mobility 
immersion of body T H2O 
Aromatherapy 
Hypnotherapy 
TENS
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17
Q

Inhalation agent used for pain relief during labour

A

Entenox

NO + O2 mix

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18
Q

SE entenox (3)

A

Light-headedness
Nausea
Hyperventilation

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19
Q

What systemic opiates are used for pain relief during labour? (2)

A

Pethidine

Meptid (IM)

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20
Q

SE foetus of systemic opiates during labour

A

Respiratory depression

reverse w/ naloxone

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21
Q

How are epidural anaesthesia delivered

A

Via epidural catheter into epidural space between L3-4/L4-5

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22
Q

Advantages - epidural anaesthesia during labour (3)

A

Only pain free method
If labour too long, can reduce BP
Abolishes premature urge to push

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23
Q

Disadvantages - epidural anaesthesia during labour (10)

A 
Occasionally ineffective 
IV access req 
Transient HOTN (after loading dose)
Mobility reduced - P sores
Urinary retention 
Maternal fever 
Increased need for instrumental delivery 
Pushing needs to be directed 
Active 2nd stage delayed
Transient bradyC
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24
Q

C/I epidural (5)

A 
severe sepsis 
Some spinal abnorm 
Active neuro disease 
Hypovolaemia 
Coagulopathy/anti-coag therapy
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25
How is spinal anaesthesia performed
LA into dura mater
26
Complications spinal anaesthesia
HOTN | Total spinal analgesia --> resp paralysis
27
How is a pudendal nn block performed
LA injected biblaterally around pudendal nn | Where it passes ischial spines
28
Indications - forceps delivery - foetal (3)
Foetal distress Face presentation Known/suspected foetal bleeding disorder
29
Indications - forceps delivery - maternal
``` Prolonged 2nd stage labour Prev pathologies: > Pre-eclampsia > Berry Aneurysm > UA > Brittle asthma > Prev pneumothorax ```
30
6 steps in forceps delivery
1 - anaesthestics for foreceps 2- ensure bladder is empty 3 - feel - is cervix still palpable? which way is head? 4 - select type of forceps 5 - If baby in OA - grease up Neville Barnes forceps + insert 6 - if baby not in correct position - grease up Keilliands forceps + use Wandering method
31
What are the 2 types of forceps
Neville Barnes Forceps - traction (fixed lock) | Kelliands forceps - rotation (sliding lock)
32
When using Neville Barnes forceps, if you do 3 pulls, and there is no descent, what to do
STOP due to damage to facial nn (b/c disproportion) hence episiotomy
33
What is the wandering method
When anterior blade is 1st inserted posteriorly and then wandered over the face to lie anteriorly
34
What is asynclitism
Oblique malpresentation of fetal head in labour
35
Indications - ventouse delivery (3)
If delayed 2nd stage labour b/c mum = exhausted If delayed 2nd stage labour b/c malposition If abnorm CTG
36
Method - ventouse delivery
KIWI cup Over posterior fontanelle Traction downwards initially, changing angle upwards as head crowns
37
how long, from application must a ventouse delivery be complete by?
15 mins
38
If foetal head is above ischial spines, what method of delivery must be used
CSC
39
Risks of assisted delivery (7)
``` Laceration to vagina Perineal trauma Rupture bladder Skull fractures Chignon (baby) Brain bleed baby Facial palsy ```
40
What is Chignon
Scalp oedema
41
Purpose of episiotomy
Increase diameter of vulval outlet
42
What episiotomy technique is used in the UK?
Epidural/ perineal infiltration w/ LA | + Mediolateral incision
43
What must be done after suturing up an episiotomy
VE | PR
44
Maternal indications episiotomy (2)
Female circumcision | If prev perineal reconstructive surgery
45
Fetal indications episiotomy (4)
Instrumental delivery Breech Shoulder dystocia Abnormal CTG
46
What % of mothers have some degree of tear during labour
70%
47
1st degree tear
SKin only
48
2nd degree tear
Skin + perineal mm
49
3rd degree tear
Incl partial/complete rupture anal sphincter
50
4th degree tear
Anal mucosa
51
Maternal indications CSC (7)
``` 2 previous LSCS Placenta praevia Maternal disease Fibroids/ovarian cyst Maternal request Active 1' genital herpes HIV ```
52
Fetal indications LSCS (7)
``` Breech Twin pregnancy - 1st not cephalic Abnorm CTG/FBS Selected cases of placental abruption Cord prolapse Delay in 1st stage labour Cephalopelvic disproportion ```
53
What incision is used in LSCS
Pfannenstiel incision
54
Steps of LSCS
``` Regional analgesia Pfannenstiel incision Empty bladder w/ catheter Rectus sheath cut + mm divided Uterovesical peritoneum incised Lower uterine segment incise transversely, fetus delivered IV Oxytocin + placenta + membranes removed Uterus closed by absorable suture ```
55
Risks CSC (7)
``` Adhesions Visceral injury Lacerations to babies face Infection Haemorrhage Gastric aspiration (Mendelsons syndrome) Thomboembolism ```
56
What is VBAC
vaginal birth after CSC
57
VBAC - risk of scar rupture
5%
58
What is shoulder dystocia
Normal traction fails to deliver shoulders after head because = too big
59
Complications of shoulder dystocia (2)
Brachial plexus damage (Erb's palsy) | Neonatal mortality
60
RF shoulder dystocia (5)
``` Diabetes / large baby Prev baby w/ shoulder dystocia Incr BMI IOL Decr maternal height ```
61
Mx shoulder dystocia
Sr obstetrician/paids Suprapubic P McRoberts maneouvre Episiotomy Transverse shoulder - int rotation of shoulder If fails: Grasp post arm. Hand brought down + trunk follows, rotate body using arm LAST resort - symphisiotomy + replacement of head + CSC
62
Mc Roberts Manoeuvre
Leg hyperextesnion onto abdomen
63
Prevalence cord prolapse
1/500
64
Complications of cord prolapse
Cord spasm --> rapid fetal hypoxia --> mortality
65
RF (5)
``` Pre-term Breech Polyhydramnios Abnorm lie Multiple pregnancy ```
66
Mx of cord prolapse
Prevent compression via finger + tocolytics If out of vag - keep warm/moist + don't force back inside Can push back present part of foetus Pt on all 4s --> CSC
67
What is amniotic fl embolism
When amniotic liquor enters the maternal circulation
68
Consequences amniotic fl embolism (4)
Maternal death Rapid DIC Pulm oedema ARDS
69
RF amniotic fl embolism (4)
ROM CSC TOP Polyhydramnios
70
Mx amniotic fl embolism
``` Resus O2 Blood - clotting/FBC/e=/Cross match Blood + FFP ICU ```
71
What is uterine rupture
A new tear or rupture of CSC scar
72
PS uterine rupture (5)
``` Constant lower abdo pain Decr Fetal HR Vaginal bleeding Cessation of contraction Maternal collapse ```
73
Complications uterine rupture (5)
Foetal extrusion Masssive internal haemorrhage Acute fetal hypoxia Neonatal mortality
74
RF uterine rupture (4)
Prev CSC Prev rupture Deep myomectomy Obstructed labour
75
Mx uterine rupture
Resus incl fl/bloods/FFP | Urgent laparotomy
76
Preventing uterine rupture (2)
Avoid IOL in VBAC | Use transverse CSC
77
What is uterine inversion
Fundus inverts into uterine cavity, usually after traction on placenta
78
Complications uterine inversion (3)
Pain Shock Haemorrhage
79
Mx uterine inversion
Attempt to push fundus throguh vagina | Replace HSP
80
RF - seizures in labour (3)
PE Epilepsy Hypoxia
81
Mx seizures in labour (5)
``` Open airway O2 Cardiopulm resus diazepam MgSO4 if /b/c PE ```

CP2 OBGYN (21 decks)

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