Obstetrics Labour Flashcards
(39 cards)
What is the criteria for Hyperemesis Gravidarum?
> 5% loss in Pregnant weight
Electrolyte disturbance
Ketosis
What is the scoring system used in Hyperemesis Gravidarum, and what is considered severe?
Pregnancy- Unique Quantification of Emesis
> 12 is severe
How is Hyperemesis Gravidarum managed?
Midl:
- Home
- anti emetics (cyclizine) + oral rehydration
Moderate:
- Day cases
- IV fluid
- IV anti-emetics (metaclopramide)
- IV thiamine
Severe:
- admitted
- IV anti-emetics (ondansetron - carries risk) or really severe: Steroids (Dexamethasone)
- IV fluids
- Pabrinex/ thiamine
- VTE prophylaxis (enoxaparin + stockings)
**note that severe you try antiemetic first then use steroids
What is the criteria for pre-eclampsia?
HTN: >140/>90
Proteinuria: >30 P:C ratio
> 20 weeks gestation
What are the stages of labour?
Stage 1:
- latent stage:
- 3-4cm dilated:
- active stage:
- Regular painful contractions
- Full dilation of cervix >10cm
- Effacement of cervix
- Crowning of baby
Stage 2:
From full cervix dilation to delivery of the head of the baby
*propulsive - head reaches pelvic floor
*Expulsive - mother wants to push
Stage 3:
- From delivery of baby to Delivery of placenta
What are the cardinal movements of the labour?
Prelabour stage:
- occipital lateral position
Engagement
- anterior occipital
- station
Extension of head
Restitution
- turning transverse so shoulders sit antro-posterior
Expulsion
What are the pro-labour hormones?
Oxytocin
- increases for of contractions
- Receptors increase via fetal adrenocorticotrophin hormone
Prostaglandins
- Increase ripening of cervix
- increase uterine contractions
Inflammatory mediators
- promote membrane rupture by collagenases
Oestrogens
What score can be used to assess how “ripe” the cervix is, and when is it used?
Bishops Score
< 3 - not ripe
> 7 ready to deliver
Used when thinking about induction of labour.
If induction was to commenced on a low Bishop score there would be increased risk of:
- prolonged labour
- fetal distress
Takes into account:
- Dilation
- length of cervix
- Consistency (firmness)
- Engagement
- Position of fetus
What is the criteria for labour?
Regular painful contractions
Effacement of cervix
Dilation of cervix
What can be used to assess the maternal and fetal condition during labour?
Partogram
- gives a graphical representation including:
Maternal HR, BP
Fetal HR
Descent
Frequency of contractions
What instrument can be used to assess fetal heart sounds?
Pinard
or
Doppler
How often should the vagina be examined during labour?
Every 4 hours
What is meant by Caput?
Refers to oedema of the scalp during labour owing to pressure of the head against the pelvic rim.
denoted by +, ++, +++
What is meant by Moulding:
Refers to the compression of the head of the fetus during labour, where the individual cranial bones move.
+: bones opposed
++: bones overlap but are reducible
+++: Overlapped and cannot be reduced
What are the clinical progress times of labour?
Stage 1:
Prim - 8- 18hours
Multi - 5.5 - 12 hours
*dilation should continue at 0.5-1cm for prim and >1cm for multi
Stage 2:
Prim - 3 hours
Multi - 2 hours
Stage 3:
30 - 1 hour
What is it called when stages 1 and 2 of labour occur in <2-3 hours, and why is it dangerous?
Precipitate delivery
Can cause fetal distress
What is considered unacceptable dilation rates causing prolonging of labour/ failure to progress?
<2cm in 4 hours
or
<0.5cm per hour
What is the indication for induction of labour?
When the risk of induces labour outweighs continuing pregnancy
- 20% of pregnancy will have this occur
potential causes:
- Failure to progress
- Maternal diabetes
- Twins
- Pre-labour rupture of membranes
- Pre-eclampsia
- Maternal request
What would be some contraindications to induction of labour?
Anything that contraindicates a vaginal birth
- Placenta Previa
- transverse lie
- breech presentation
- cord prolapse
- genital herpes
Caution with:
- previous C section - risk of scar rupture
Why is Continual cardiotocography monitoring required when inducing labour?
Induction can cause uterine contractility reducing blood flow, compromising fetus
What are the methods used for inducing labour?
Bishop score <6:
- Prostaglandins (intra-vaginally).
- repeat if needed
- when >6 move to:
Bishop Score >6:
- artificial rupture of membranes
+
- Syntocinon (Oxytocin)
What is the inhaled analgesia used during labour?
Entonox
- 50:50 of oxygen and nitrogen
What opioid should be used in pregnancy and when should it be avoided?
Diamorphine
Avoid if possible within 4 hours of delivery
When is the APGAR score done?
1, 5, 10 minutes after birth
