Mx of Labour and Delivery Flashcards
(98 cards)
1
Q
Signs that labour is on the way (4)?
A
Braxton Hicks contractions become > freq
Pressing part becomes
Uterine fundus descends
P in pelvis increases
2
Q
Diagnosis of labour
A
Painful uterine contractions + dilation + effacement of cervix
3
Q
Stage 1 labour
A
Cervix opens –> full dilation (10cm)
4
Q
Stage 2 labour
A
Cervical dilation –> delivery
5
Q
Stage 3 labour
A
Delivery foetus –> delivery placenta
6
Q
What are the 3 factors determining the progression of labour?
A
Powers
Passage
Passenger
7
Q
What is ‘Power’
A
Degree of force expelling foetus
8
Q
What is ‘Passage’
A
Dimension of pelvic + resistance of soft tissue
9
Q
What is ‘Passenger’
A
Diameter of foetal head
10
Q
What is effacement
A
The cervix being pulled up
11
Q
Dimensions of pelvic inlet
A
TD - 13cm > AP - 11cm
12
Q
Dimensions of pelvic mid-cavity
A
TD = AP
13
Q
Dimensions of pelvic outlet
A
AP - 12.5 > TD 11cm
14
Q
How is the level of descent measured?
A
From Ischial spines
15
Q
What 3 things does cervical dilation depend on?
A
Contractions
P of foetal head
Ability to soften
16
Q
Name of anterior fontanelle
A
Bregma
17
Q
Name of posterior fontanelle
A
Occiput
18
Q
what is between the bregma and occiput?
A
Vertex
19
Q
What is attitude
A
Degree of flexion of head/neck
20
Q
What is the ideal attitude?
A
Vertex presentation (maximal flexion) Presenting diameter - 9.5cm
21
Q
What has a diameter of 13cm
A
Extension 90’
Brow presentation
22
Q
What has a diameter too large to deliver?
A
Face presentation
exxtension 120’
23
Q
What is position
A
Degree of rotation of head on neck
24
Q
What is moulding
A
Head is able to be squashed with bones overlapping hence decr diameter
25
What occurs in the initiation of labour
Involuntary contraction of uterine SM
| Incr PG --> Decr cervical resistance + oxytocin released
26
Latent phase stage 1 labour
Cervix dilates slowly for first 4cm. This can take several hrs
27
Active phase stage 1 labour
Rate of 1cm/hr nulliparous
| Rate 2cm/hr multiparous
28
What is the longest stage 1 of labour should take?
16hrs
29
4 stages of stage 2 of labour
Descent --> flexion --> rotation --> extension
30
Passage stage 2 labour
Full dilation - head reaches pelvic floor
| Lasts mins
31
Active stage 2 labour
Mother is pushing
| Pressure of head on pelvic flr forces women to bear down
32
How long does active stage 2 take nulliparous woman
40 mins
33
How long does active stage 2 take multiparous women
20 mins
34
After reaching the perineum, how does the head come out of the pelvis
It extends
35
After the head extends, what comes next
Head rotates back to transverse position + descend w/ next contraction
36
How long does stage 3 labour normally take?
15 mins
37
What is the normal blood loss in the 3rd stage of labour?
500ml
38
Obs - what should be checked every 15 mins
Foetal HR
39
Obs - what should be checked every 30 mins
Uterine contractions
40
Obs - what should be checked every 1hr
Maternal HR
41
Obs - what should be checked every 4hours
VE
Maternal BP + temp
Urine dip - protein + ketones
42
Which positions are good for delivery? (3)
Squatting
Kneeling
L lateral position
43
Why should women in labour not lie in the supine position?
Aortocaval compression --> Incr CO + Decr BP
44
Mx pyrexia in labour
Take cultures from - vagina, urine, blood
| Give - paracetamol, IV ABx, CTG
45
How anxiety and fear affect labour
Adrenaline secreted
| Inhibition of uternie contraction
46
What is the most common cause of slow progress through labour?
Inefficient uterine action
47
Who is more likely to have inefficient uterine action
Nulliparous women
| IOL/Epidural
48
Mx Inefficient uterine action
Continuous support - reduce anxiety
Encourage mobility
Augmentation of labour --> amniotomy + oxytocin
CSC if not by 12-16hrs
49
Affect of hyperactive uterine action (3)
Decr placental blood flw
Rapid labour
Placental abruption
50
Tx hyperactive uterine action
If no abruption - tocolysis
| CSC if foetal distress
51
Augmentation
Artificial strengthening of contractions in established labour
52
Induction
Artificial initiation of labour
53
Effect of OP persentation on labour
Incr time + Pain
| Backache + early desire to push
54
Mx of OT presentation
Rotate with traction using ventouse
55
What is Brow presentation?
Extension of foetal head --> large presenting diameter --> won't deliver vaginally
56
What can you feel on VE in Brow presentation?
Anterior fontanelle supraoribital ridges + noses palpable
57
Mx Brow presentation
CSC
58
What is face presentation?
Complete extension of foetal head hence face presents
59
What can you feel on VE in face presentation?
Mouth, nose + eyes palpable
60
Mx face presentation
Can deliver vaginally
61
When would you need a CSC for face presentation?
If chin = posterior
62
Who is cephalo-pelvic disproportion more common for? (2)
Large baby
| Short woman
63
Severe causes of damage to foetus during labour (5)
```
Hypoxia
Infection/inflammation in labour
Meconium aspiration
Trauma
Foetal blood loss
```
64
RF/causes of foetal damage during labour (8)
```
Long labour
>1hr pushing time
Abruption
Hypertonic uterine state
Use of oxytocin/epidural
Cord prolapse
Maternal hypotension
Pre-eclampsia
```
65
ways of Diagnosis of foetal distress in labour (4)
Colour of meconium
FHR
CTG
FBS
66
How often is FHR ausculatated in 1st stage labour
Every 15mins
67
How often is FHR ausculatated in 2nd stage labour
Every 5 mins
68
How is a FBS taken?
Amnioscope inserted vaginally --> cervix --> babies scalp --> collect blood
69
Mx of foetal distress in labour
```
In utero resus =
L-lateral position
O2 + IV fl
Stop oxytocin
Can stop contractions w/ B2 agonist e.g. terbutaline
VE - exclude prolapse
```
70
What is the rate of O2 consumption of a foetus compared to an adult?
2x
71
How long can a foetus be supported by its O2 reserves?
1-2mins
72
What are the 5 main groups of reasons a fetus's O2 can be impaired?
```
Placental conditions
Maternal conditions
Fetal condition
Uterine condition
Umbilical cord condition
```
73
3 examples of placental conditions affecting foetal O2 supply
Infarction
Abruption
Post-mature placenta
74
6 examples of maternal conditions affecting foetal O2 supply
```
HTN
HoTN
Severe anaemia
Cardiac disease
Seizures
Pulmonary disease
```
75
3 exams of foetal conditions that affect foetal O2 supply
Anaemia
Infection
Twin-twin transfusion
76
2 examples of uterine conditions affecting foetal O2 supply
Tetanic contraction
| Hyperstimulation
77
5 examples of umbilical cord condition that affect foetal O2 supply
```
One aa
Haematoma
Short cord
True knot
Nuchal cord prolapse
```
78
Which develops first, the SNS or paraSNS
SNS
79
Indications CTG (17)
```
IOL
>42weeks
Previous LSCS
Maternal cardiac problems
Pre-eclampsia or HTN
Prolonged rupture membranes >24hrs
<37weeks
Small for gestation age
Oligohydramnios
Abnormal umbilical aa Doppler
Multiple pregnancy
Meconium stained liquor
Abnorm lie - Breech
Oxytocin augmentation
Epidural anaesthesia
Pyrexia
Abnormality heard on ausc
```
80
What is the false +ve rate of CTG for fetal hypoxia?
50%
81
DR C BRAVADO
```
DR - determine risk
C - contractions
BRA - baseline HR
V - variability
A - accelerations
D - decelerations
```
82
What should the Baseline heart rate of a fetus be?
100-160
83
Causes of sustained tachyC (4)
Prematurity
Fetal hypxia
Maternal pyrexia
Use of exogenous B-sympathomimetics
84
Causes of baseline bradycardiac (3)
Fetal acidosis
HoTN
Maternal sedation
85
What should variability be between?
5-25
86
What is variability
The interplay between CNX (PNS) and SNS
87
Causes of reduced variability (6)
```
Baby sleeping (40mins)
Fetal hypoxia
Malformation
Mg
Prematurity < 2w
Dx - pethidine, morphine
```
88
What is an acceleration
Upward spike of >15bpm for >15s
89
What does an acceleration mean
Baby is moving
90
What is a deceleration
Downward spike of >15bpm for >15s
91
What are early decelerations
Baroceptor decelerations
| Mimic shape + timing of contraction by foetal head compression
92
What are late decelerations
Chemoreceptor decelerations
| Signs of acidosis
93
What is an atypical deceleration
Loss of shouldering, last >60s, >60bpm, may be slow to recover by a W shape + lose variability with the decelerations
94
What may atypical decelerations be a sign of?
Fetal hypoxia
95
3 classifications of CTG
Reassuring
Non-reassuring
Abnormal
96
How to improve a CTG (3)
L Lateral position
IV fl
Reduce/stop oxytocin if contraction >5:10 or bradyC
97
WHy is hyperstimulation bad (2)
Increases resting tone of uterus
| O2 in retroplacental blood pool isn't properly replenished betw contractions
98
Mx hyperstimulation
Terbutaline 250mg
