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Flashcards in Normal Labour Deck (15)
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1
Q

4 main fetal lie’s

A

cephalic / breech / transverse / shoulder

2
Q

what is caput?

A

oedema of the fetal scalp

3
Q

3 stages of labour?

A

1st stage: (split latent and active)

  • Latent = onset contraction to 3cm dilation
  • Active = 3cm to fully dilated

2nd : full dilation until delivery of child
3rd : delivery of child until placenta delivered

4
Q

signs of placental delivery

A

rush of blood / lengthening of cord / relaxation of uterus

5
Q

length of each stage (prim and parous)

A

1st: prim = 12 hours/ parous = 7.5
2nd: 45-120 mins / 15-45 mins
3rd: similar

6
Q

managment of stages

A

1 + 2 = assess progress every 2-4 hours via Partogram graph (time / cerv dilation + vital signs) as well as abdomen and Vag exam –> effacement, dilation, station, position

also maternal health = contractions, pulse, BP, temp as well as urine (if ketotic give IV dextrose)

3 = oxytocin(syntometrine) / early cord clamping (only if baby asphixiated) / controlled cord traction/ monitor for PPH signs

7
Q

why use oxytocin? effects?

A

promotes continuation of contractions

decrease PPH / decrease time taken for 3rd stage // can increase MI risk

8
Q

CI to giving oxytocin

A

pre-eclampsia, hypertension, liver or renal impairment

9
Q

process of delivery

A
descent and flexion of head
internal rotation
extension of head and delivery
restitution
external rotation and deliver shoulders
10
Q

induction of pregnancy - ? / how many in uk? / indications

A

artifically rupturing the membranes / 20% of pregs /

DM / prev stillbirht / abruption / twins / fetal death in utero / placental insuff

11
Q

contra-ind of induction

A

fetal distress, placenta praevia, pelvic tumor, cord presentation, intra0uterine growth retardation

12
Q

dangers of induction

A

infection, bleeding, cord prolapse, c-section/forceps increase risk

13
Q

methods of induction

A
Membrane Sweep (releases prostaglandings/ best done 40+ weeks
Vaginal PGE2 = prostin
ARM(amniotomy) = must be done before oxytocin given
Oxytocin (syntocinon) = infusion per regime
14
Q

pain relief in labour options

A
  • entonox (N2O and O2) started before pain does
  • systemic opiates (IM diamorph/pethidine) given in 1st stage labour/not given if delivery imminent
  • epidural (bupivicaine/ fentanyl) generally anaesthatising nerves T11 to S5. Given once labour establised (>3cm) but wait >12 hours after LMWH dose.
  • combined spinal epidural
  • local anaesthesia - given for episiotomy (perineal nerve) or forceps (pudendal nerve)
  • Gen Anaesthetic - emergency only
15
Q

effects of epidural + why combined spinal epidural best?

A

hypotension (give hartmanns to prevent) / paralysis / urine retention

must be assessed every 15 mins and topped up every 2 hours

combined is better as: quicker / less motor blockade / pt dose controlled