Normal pregnancy and labour Flashcards

Question

GI system adaptions in pregnancy

Answer 1

Upward displacement of stomach → increase in intra-gastric pressure → predispose mother to reflux Increase in progesterone → smooth muscle relaxation, with decreases gut motility → more time for nutrient absorption but can lead to constipation Relaxation of gallbladder → biliary tract stasis → predisposes mother to gallstones

Answer 2

Increased CO → increase in renal plasma flow which increases GFR by ~50% Progesterone relaxes ureter & muscles of bladder → predispose to urinary stasis causing infections

Answer 3

Increase in fibrinogen & clotting factors in blood & decrease in fibrinolysis Increase risk of thromboembolic disease LMWH choice of drug if necessary to give mother an anticoagulant drug Physiological dilutional anaemia → plasma volume increases significantly but red cell mass does not increase by as much

Answer 4

Physiological process by which a foetus is expelled from the uterus to the outside world

Answer 5

Throughout third trimester, involuntary contractions of the uterine smooth muscle begin to occur Occur irregularly and are thought to be a form of ‘practice contraction’

Answer 6

Softening of the cervix that occurs before labour Occurs in response to oestrogen, relaxin and prostaglandins (synthesis increases in 3rd trimester due to increased oestrogen:progesterone) Ripening involves: - reduction in collagen - increase in glycosaminoglycans - increase in hyaluronic acid - reduced aggregation of collagen fibres Means cervix offers less resistance to presenting part of fetus during labour

Answer 7

Relative decrease in progesterone in relation to oestrogen that occurs towards the end of pregnancy helps to facilitate an increase in the excitability of the uterine musculature Mechanical stretching of the uterus also helps to increase contractility → foetus grows, contractility of muscle increases

Answer 8

Responsible for initiating uterine contractions 36 weeks, under influence of oestrogen, increase in number of oxytocin receptors present with the myometrium → uterus begins to respond to pulsatile release of oxytocin from the posterior pituitary gland Ferguson reflex → positive feedback loop → contractions lead to more oxytocin being released leading to stronger contractions

Answer 9

Results in the creation of the birth canal and lasts from the beginning of labour until the cervix is fully dilated (~10cm) Contractions will occur every 2-3 minutes, foetal membranes rupture if haven’t already Latent phase → slow cervical dilatation over several hours which lasts until the cervix has reached 4cm Active phase → faster rate of cervical dilatation until 10cm reached; phase should normally last longer than 16 hours

Answer 10

Lasts from full dilatation of the cervix until the foetus has been expelled Passive stage - lasts until the head of the foetus reaches the pelvic floor; rotation and flexion of the head are completed in this stage; few minutes Active stage - pressure of the foetal head on the pelvic floor results in an urge to ‘bear down’ → woman pushes in conjunction with her contractions in order to expel the foetus - 40 mins in nulliparous women, 20 minutes in multiparous women, > 1 hour = spontaneous labour becomes unlikely

Answer 11

Once head reaches perineum → extends in order to come up and out of pelvis Following delivery of head → rotated by 90 degrees to assist with shoulders Anterior shoulder delivers first, body flexes laterally and anteriorly to help deliver the posterior shoulder Once shoulder have been delivered → rest of body follows

Answer 12

Follows delivery and lasts until the placenta has been delivered Uterine muscle fibres contract to compress the blood vessels supplying the placenta → shears away from the uterine wall Typically lasts 15 minutes & up to 500ml blood loss Normal mechanisms to control bleeding: - contraction of the uterus constricts blood vessels in the myometrium - pressure exerted on placental site once it has been delivered by uterus - normal blood clotting mechanism

Answer 13

Refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons

Answer 14

1 - partial/total removal of the clitoris and/or the prepuce 2 - partial/total removal of the clitoris and labia minora, with or without excision of the labia majora 3 - narrowing of the vaginal orifice with creation of covering seal by cutting & appositioning the labia minora and/or labia majora, with or without excision of the clitoris 4 - all other harmful procedures to female genitalia for non-medical purposes e.g. pricking, piercing, incising, scraping & cauterisation

Answer 15

Begin on the first day of the LMP, subtract 3 months, add 7 days, and then add 1 year

Answer 16

Length of menstrual cycle Date of last period may be incorrect - may think implantation bleeding is LMP

Answer 17

Pain in the front and/or back of the pelvis, which may affect other areas such as the hips or thighs Usually caused by the joints moving unevenly, which can lead to the pelvic girdle becoming less stable & painful

Answer 18

Physiotherapy - exercises, avoid triggers, manual therapy Can still have normal vaginal birth Usually improves after birth

Answer 19

Refers to when labour is not developing at a satisfactory rate

Answer 20

Less than 2cm of cervical dilatation in 4 hours Slowing of progress in a multiparous women

Answer 21

Active second stage lasts over: - 2 hours in a nulliparous woman - 1 hour in a multiparous woman Interventions: - changing positions - encouragement - analgesia - oxytocin - episiotomy - instrumental delivery - c-section

Answer 22

Amniotomy (ARM) for women with intact membranes Oxytocin infusion - first line to stimulate uterine contractions during labour Instrumental delivery C-section

Answer 23

Pregnancy-related tissue remain in the uterus after delivery Can also occur after miscarriage or termination of pregnancy

Answer 24

Vaginal bleeding that gets heavier/does not improve with time Abnormal vaginal discharge Lower abdominal or pelvic pain Fever (if infection occurs) Diagnosis made by USS

Answer 25

Surgical removal - evacuation of retained products of conception - cervix widened, retained products are manually removed through the cervix using vacuum aspiration & curettage - complications - endometritis & Asherman’s syndrome

Answer 26

Adhesions form within the uterus Endometrial curettage can damage the basal layer of the endometrium Damaged tissue may heal abnormally, creating scar tissue connecting areas of the uterus that are generally not connected → can lead to infertility

Answer 27

Used to measure the fetal heart rate and the contractions of the uterus Can help guide decision making and delivery

Answer 28

Two transducers are placed on the abdomen to get the CTG readout: - one above the fetal heart → uses Doppler US - one near the fundus of the uterus to monitor the uterine contractions → assess tension in the uterine wall

Answer 29

Sepsis Maternal tachycardia (> 120) Significant meconium Pre-eclampsia Fresh antepartum haemorrhage Delay in labour Use of oxytocin Disproportionate maternal pain

Answer 30

Concerning finding Fetal HR drops in response to hypoxia - early decelerations - gradual dips and recoveries in HR that correspond with uterine contractions; normal → caused by uterus compressing the head of the fetus, stimulating the vagus nerve, slowing the HR - late decelerations - gradual falls in HR that starts after the uterine contraction has already begun → caused by hypoxia - variable decelerations - abrupt decelerations that may be unrelated to uterine contractions; intermittent compression of the umbilical cord - prolonged decelerations - last between 2 and 10 mins with a drop of more than 15bpm, indicates compression of the umbilical cord, causing fetal hypoxia

Answer 31

Escalating to a senior midwife and obstetrician Further assessment for possible causes - uterine hyperstimulation, maternal hypotension & cord prolapse Conservative interventions - repositioning the mother or giving IV fluids for hypotension Fetal scalp stimulation - acceleration in response reassuring sign Fetal scalp blood sampling - test for fetal acidosis Delivery of baby - instrumental or emergency CS

Answer 32

Assess features of a CTG in a structured way DR - define risk C - contractions BRa - baseline rate V - variability A - accelerations D - decelerations O - overall impression

Answer 33

Occurs where the external vaginal opening is too narrow to accommodate the baby

Answer 34

First degree - injury limited to the frenulum of the labia minora and superficial skin Second degree - including the perineal muscles, but not affecting the anal sphincter Third degree - including the anal sphincter, but not affecting the rectal mucosa Fourth degree - including rectal mucosa

Answer 35

Sutures Broad-spectrum abx to reduce the risk of infection Laxatives to reduce the risk of constipation Physiotherapy Follow-up Elective CS in subsequent pregnancies

Answer 36

Short-term: pain, infection, bleeding, wound dehiscence or wound breakdown Long-term: urinary incontinence, anal incontinence & altered bowel habit, fistula, sexual dysfunction & painful sex, mental health consequences

Answer 37

Obstetrician or midwife cuts the perineum before the baby is delivered Done in anticipation of needing additional room for delivery of the baby

Answer 38

Method for reducing the risk of perineal tears Involves massaging the skin and tissues between the vagina and anus Done in a structured way from 34 weeks onwards to stretch and prepare the tissues for delivery

Answer 39

Recommended for the first 6 months of life, with introduction of solid food around this time & continued breastfeeding up to 2 years of age or longer

Answer 40

Lowers risk of: - breast cancer - ovarian cancer - osteoporosis - CVD - obesity

Answer 41

Reduces risk of: - infections - D&V - SIDS - obesity - CVD in adulthood

Answer 42

Used during contractions for short term pain relief Woman takes deep breaths using a mouthpiece at the start of a contraction, the stops using it as the contraction eases Can cause lightheadedness, nausea or sleepiness

Answer 43

Opioid medications usually given by IM May help with anxiety and distress May cause drowsiness or nausea in the mother & can cause respiratory depression in the neonate if given too close to birth

Answer 44

Patient controlled IV remifentanil Requires careful monitoring Access to naloxone for respiratory depression & atropine for bradycardia

Answer 45

Inserting a small tube into the epidural space in the lower back Local anaesthetic medications are infused through the catheter into the epidural space → surrounding tissues & spinal cord Offers good pain relief during labour Adverse effects: - headache - hypotension - motor weakness in the legs - nerve damage - prolonged second stage - increase probability of instrumental delivery Urgent anaesthetic r/w if motor weakness → catheter may be in the subarachnoid space

Answer 46

PROM - rupture of fetal membranes at least one hour prior to the onset of labour, at > 37 weeks gestation P-PROM - rupture of fetal membranes occurring <37 weeks gestation

Answer 47

Combination of factors can lead to the early weakening & rupture of fetal membranes: - early activation of normal physiological processes - infection - genetic predisposition

Answer 48

Smoking (< 28 weeks gestation) Previous PROM/pre-term delivery Vaginal bleeding during pregnancy Lower genital tract infection Invasive procedures eg. amniocentesis Polyhydramnios Multiple pregnancy Cervical insufficiency

Answer 49

Hx of ‘broken waters’ Gradual leakage of watery fluid from vagina Damp underwear/pad Change in the colour/consistency of vaginal discharge O/E - speculum: pooling of fluid in the posterior vaginal fornix; lack of normal vaginal discharge

Answer 50

Actim-PROM - swab test looking for IGFBP-1 in vaginal samples (100-1000x conc in amniotic fluid) Amnisure - looks for placental alpha microglobulin (found in large concentrations in amniotic fluid) USS - not routine High vaginal swab - GBS

Answer 51

Monitor for signs of clinical chorioamnionitis Clindamycin/penicillin during labour if GBS Watch & wait for 24 hours/consider IOL IOL & delivery recommended if > 24 hours

Answer 52

Monitor for signs of clinical chorioamnionitis & advise patient to avoid sexual intercourse Prophylactic erythromycin for 10 days Clindamycin/penicillin during labour if GBS isolated Corticosteroids if between 34 and 34+6 weeks gestation IOL & delivery recommended

Answer 53

Monitor for signs of clinical chorioamnionitis Advise patient to avoid sexual intercourse Prophylactic erythromycin for 10 days Corticosteroids Aim expectant mx until 34 weeks

Answer 54

Chorioamnionitis Oligohydramnios Neonatal death - prematurity, sepsis & pulmonary hypoplasia Placental abruption Umbilical cord prolapse

Normal pregnancy and labour Flashcards

(78 cards)