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YR 3 MED > OBS & GYNAE WK 5 > Flashcards

OBS & GYNAE WK 5 Flashcards

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1
Q

NORMAL LABOUR - 3 STAGES

A
  1. Cervical effacement and dilatation
    latent/active stage (8-24hrs)
  2. FULL dilatation and delivery of the baby (0-30mins)
  3. BIRTH OF PLACENTA
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2
Q

3Ps - failure to progress or obstructed labour

management for each

A

power - insufficient uterine activity
passenger - baby too big
passage - mum has small pelvis

Artificial rupture of the amniotic membranes (ARM)
forceps/suction cup

malpresentation

mcroberts position - lifting legs up and in case of shoulder dystocia

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3
Q

Augmentation of labour
how to induce labour - pros and cons

A

breaking water, need to be dilated to rupture
propess

bring forward delivery to reduce risk to mum and baby eg. diabetes, reduced movements

more painful than the actual birth
need more exams and monitoring

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4
Q

breech position

A

instead of head first, its feet are
LUSCS - lower uterine segment caesarean section
ECV - External cephalic version

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5
Q

chorioamnionitis - and mx

A

intra-uterine infection, infection of placenta and the amniotic fluid - may be life threatening

abdo pain, offensive discharge, mum unwell

PPROM - preterm premature rupture of membranes

PROM

IV antibiotics, C-section DELIVERY

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6
Q

APH aka antepartum haemorrhage - before childbirth

CAUSES??

MX??

A

vaginal bleeding from 24 + 0 weeks until birth

don’t do digital exam until u can exclude PLACENTA PRAEVIA

caused by PLACENTAL ABRUPTION OR PRAEVIA

Kleihauer, anti-d, steroids for baby

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7
Q

cord prolapse - mx??

A

may obstruct blood supply to baby
RAPID DELIVERY via section

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8
Q

shoulder dystocia

risk factors ??

mx

A

baby anterior shoulder stuck against mother pelvis, pubic symphysis bone
causing delayed delivery and hypoxia

risk factors - diabetes, big head baby and narrow pelvis, BMI>30, short stature, slow labour, IOL, FORCEPS

HELPERR mx - call for help
evacuate for episiotomy
legs - mcroberts manoeuvre
external pressure - suprapubic

need to get baby out <4 mins or may risk permanent neurolgocial damage, Brachial plexus injury

may have to break baby’s clavicle to help narrow space

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9
Q

amniotic fluid embolism and maternal collapse

A

Rare complication of labour where amniotic fluid enters systemic circulation and causes acute respiratory and circulatory collapse with coagulopathy

Maternal collapse can arise from numerous pathologies including
Haemorrhage (Obstetric and non obstetric)
Pulmonary embolism
MI
AFE
Septic shock
Eclampsia/Epilepsy

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10
Q

uterine inversion

A

uterus turning inside out after delivery

neurogenic shock

push uterus back in

delivery of placenta and then theatre

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11
Q

vaginal / perineal tears and Obstetric Anal Sphincter Injury - degrees??

A

1st Degree
Vaginal mucosa / perineal skin only
2nd Degree - most common
Includes perineal skin + muscles but does not involve anal sphincter
3A tear
<50% of external anal sphincter torn
3B tear
>50% of EAS torn
3C tear
>50% EAS and IAS (internal) torn
4th degree tear
Tear involving anal/rectal mucosa

repair in theatre

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12
Q

maternal collapse

A

acute event involving the cardiorespiratory systems and/or CNS

maternal cardiac arrest may occur

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13
Q

most common cause of maternal collapse?? other specific condition causes

A

vasovagal

anaphylaxis
eclampsia
aortic dissection
hypoglycaemia
sepsis
PE
Drugs eg. MgSO4
amniotic fluid embolism

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14
Q

4Hs and 4Ts - causes of collapse in pregnancy

A

-hypovolaemia
-hypoxia
-hypokalaemia and hyponatraemia
-hypothermia

-toxicity
-thromboembolism
-tension pneumothroax
-tamponade

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15
Q

MEOWS score

A

modified early obstetric warning score

1 red / 2 amber = review

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16
Q

cpr in pregnant woman

SPECIAL MODIFICATIONS

A

During chest compressions, place your hands slightly higher than usual. This is because the pregnant woman’s diaphragm is elevated, and her heart is positioned higher in her chest.

manually displace the pregnant woman’s uterus to her left side, in a technique called “left lateral tilt.” = relieve pressure on IVC

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17
Q

perimortem caesarean

A

4 minutes post-arrest and completed at 5 minutes

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18
Q

PPH - what is major volume??

CAUSES, 4Ts

can be primary or secondary, up to 6 wks after birth

A

postpartum haemorrhage
>1000ml
but can be proportionate to body weight

tone - uterine atony
trauma - perineal tears, cervical tears
tissue - retained placenta
thrombin - coagulation problems

IV syntocinon
carboprost
misoprostol

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19
Q

calculating volume - body weight

A

50 kg -> 5000ml

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20
Q

PPH medical mx

A

ABCDE (may have to go to theatre)
UTERINE TONICS:
1. SYNTOCIN
2. ERGOMETRINE

tranexamic acid

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21
Q

PPH surgical mx

Study These Flashcards
A

intrauterine balloon - saline inside
brace sutures

22
Q

mx of 3rd stage - up to how long do you do this

Study These Flashcards
A

delivery of placenta
30 mins max

23
Q

morbidly adherent placenta

Study These Flashcards
A

becoming more common if previous CS OR UTERINE SURGERY

placenta is abnormally stuck to womb, normally is at decidua
accreta (end of womb), increta, percreta

may have to have hysterectomy

24
Q

uterine inversion

Study These Flashcards
A

usually pulled the placenta cord too hard
v rare

25
postpartum sepsis rx?? most common sources??
risk factors - anaemia, long labour, assisted delivery, raised BMI, diabetes, prolonged membrane rupture most common - uterus (endometritis) skin/wound infection breasts
26
the fetal circulation - 3 shunts
ductus venosus foramen ovale ductus arteriosus small fraction of RV output goes via lungs
27
umbilical cord has how many blood vessels?? what are they?
3 blood vessels – one vein which carries oxygenated blood to the baby, 2 arteries which carry deoxygenated blood back to the placenta
28
Duct smooth muscle __________ in response to oxygen.
constricts
29
thermoregulation - babies lose heat by what 4 methods in utero/preparation vs after delivery
radiation convection conduction evaporation Mum responsible for thermoregulation Lots of brown fat laid down between scapulae and around internal organs in 3rd trimester Less in growth restricted or preterm infants after delivery: Heat produced by breakdown of stored brown adipose tissue in response to catecholamines
30
glucose homeostasis
-Babies in utero have a constant supply of glucose from the placenta -blood sugar drops when born which is normal watch out for babies w diabetes, too much insulin
31
breast feeding feedback loop what is the earliest milk??
suckling - more feeding, more prolactin produced, more milk. earliest milk is colostrum, v rich in immune and growth factors
32
what % is normal weight loss at beginning
10% babies have excess fluid, water
33
PPHN
Persistent Pulmonary Hypertension of the Newborn the pulmonary resistance does not drop for some reason, DUE TO hypoxia, acidosis, cold stress, lung disease, sepsis
34
DIAGNOSIS AND MX OF PPHN
Measuring pre and post ductal oxygen saturations with a sats probe on the right hand and one on a foot helps to make the diagnosis. Usually there will be a 10-20% difference in saturation between the two. Ventilation Oxygen Nitric oxide Sedation Inotropes ECLS
35
transient tachypnoea
A more minor problem this time mainly with lung transition. usually need more oxygen or CPAP common reason for mums and babies to have to be separated in the first few hours of life and has an effect on feeding being established and on bonding
36
where do most of the oxygenated blood from the placenta go to, via what? what about the rest??
crosses straight over from right atrium (via the ductus venosus, inferior vena cava) to left atrium, via the foramen ovale -> left ventricle The rest, mixed with SVC return passes into the right ventricle. 
37
what substance is produced in the placenta and metabolised quickly in lung
Prostaglandin It maintains duct patency and may have a role in suppressing breathing in fetal life. 
37
causes of Failure of cardiorespiratory adaptation
hypoxia premature cold stress congenital pneumonia meconium aspiration
38
placental abruption
vasospasm, blood gets into amniotic sac, blocks cervix CTG - foetal heart, C-section
39
placental praevia
placenta lies directly over internal os severe abdo pain risk factors include previous C-sections painless vag bleeding usually in 3rd trimester
40
vasa praevia
It occurs when the blood vessels from the placenta or umbilical cord block the birth canal. triad of rupture of membrane, painless bleed and foetal bradycardia. Assisted conception, such as IVF, a low-lying placenta and multiple pregnancies can increase the risk of vasa praevia. US TA AND TV with doppler
41
maternal sepsis - signs
offensive discharge sore throat rash (meningitis?) abdo pain dysuria urinary frequency, dysuria productive cough temp >38 hr > 100 bpm resp rate > 20 confusion mental state
42
mx of sepsis
ABCDE Sepsis 6 bundle FBC, U+Es, LFTs, glucose, Lactate HVS, throat swab (group A strep?), MSSU IV co-amoxiclav within the GOLDEN HR
43
GBS - GROUP B STREP
pretty common give Benz-penicillin
44
mastitis
inflammation of mammary gland, painful, unilateral still need to breastfeed from that side 1.breastfeeding or expressing to empty breast, warm compresses 2. flucloxacillin if its staph 3.no response, referral
45
epidural abscess
rare cause of sepsis back pain and fever high death rate IV antibiotics
46
what hormonal factors influence the onsset of labour ? - 3
progesterone - keeps uterus settled oestrogen - uterus contracts oxytocin - initiates and sustains contractions
47
bishops score
to see if it is safe to induce labour position consistency effacement dilatation station in pelvis 4 or less score indicates unfavourable cervix
48
Braxton hicks contractions vs true labour contractions
false labour giving false sense that woman is having real contractions true = timing of contractions become evenly spaced and time between them gets shorter
49
delayed cord clamping
immediate clamping can reduce the red blood cells that infant receives, may cause more problems
50

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