Women's health - Labour + delivery + postpartum Flashcards
(110 cards)
1
Q
What are the stages of labour?
A
- First stage - until fully dilated (10cm)
- Second stage - full dilation until delivery
- Third stage - delivery of baby until delivery of placenta
2
Q
What is stage 1 of labour divided into and what are the criteria (2)?
A
- Latent = 0-3/4 cm dilated
- Active(established labour) = 3/4-10 cm dilated
3
Q
What are the 4 signs of the start of labour?
A
- Regular painful contractions
- Show (mucous plug from cervix)
- ROM
- Dilating + thinning (effacement) cervix
4
Q
What is stage 2 of labour divided into?
A
- Passive stage - head descends down pelvis
- Active phase - mother bears down
5
Q
How long should the first two stages of labour last in a primigravida women?
A
- Latent stage 1 = less than 20 hours
- Active stage 1(established labour) = 1 cm/hour
- 2nd stage = 2 hours
6
Q
How long should the first two stages of labour last in a multigravida women?
A
- Latent stage 1 = less than 14 hours
- Active stage 1 (established labour) = 1.5 cm/hour
- 2nd stage = 1 hour
7
Q
How long should 3rd stage last?
A
30 minutes
8
Q
What is important to give to some mothers during labour (not to do with progression or pain management) (2)?
A
- IV benzylpenicillin (if GBS infection)
- Anti-D Ig
9
Q
What are contractions in the 2nd/ 3rd trimesters that do not progress to labour known as?
A
Braxton-hicks contractions
10
Q
What influences the progression of labour (3)?
A
Three Ps
* Power - uterine contractions
* Passenger - size, presentation
* Passage - shape + size of pelvis/ soft tissues
11
Q
What are the seven stages of the mechanism of delivery?
A
- Descent - head moves down pelvis
- Flexion - chin to chest
- Internal rotation - to occipital-anterior position
- Extension - of head to push through vagina
- Restitution - occiput re-aligns with shoulders
- External rotation - shoulders rotate to anterior-posterior position (perpendicular to mothers)
- Delivery of shoulders - anterior shoulder delivered, then posterior
12
Q
What is involved in an initial assessment of a woman in labour (4)?
A
- History
- Obs + urinalysis
- Abdominal palpation - lie, contractions, engagement, ect
- Vaginal exam
13
Q
What is the standard monitoring performed during labour (5)?
A
- Foetal HB (every 15 min)
- Contractions (every 30 min)
- Maternal pulse + BP
- Vaginal exam (every 4 hours)
- Urine dip (every 4 hours)
14
Q
What is recorded on a partogram (lots of things)?
A
- Progress - dilation, descent, contractions
- Foetal wellbeing - CTG, amniotic fluid colour
- Maternal wellbeing - pulse, BP, temp, urinalysis
15
Q
What does CTG stand for?
A
Cardiotocography
16
Q
What are some indications for CTG (3)?
A
- Unwell mother (tachycardia, sepsis, bleeding)
- Delay in labour
- Use of oxytocin
17
Q
What is monitored on a CTG (2)?
A
- Foetal heartbeat
- Uterine contractions
18
Q
What are 4 reassuring features of a CTG?
A
- Rate = 110-160
- Decelerations = absent
- Accelerations = present
- Baseline variability = 5-25 bpm
19
Q
What is an acceleration/ deceleration on a CTG?
A
Increase/ decrease of 15 bpm for 15 seconds
20
Q
What are the types of deceleration and what do they mean? (4)
A
- Early (heart rate drops in time with peak of contraction) = innocent finding associated with compression of foetal head
- Late (HR drops after peak of contraction) = foetal distress e.g. hypoxia
- Variable (<2 min) = transient umbilical cord compression
- **Prolonged ** (2-10 min) = compression of umbilical cord
21
Q
What is the most common cause of reduced foetal HB variability (<5)?
A
Sleeping foetus
22
Q
How can foetal distress be further investigated, after a CTG has been done, during labour?
A
Foetal scalp sample
can indicate hypoxia
23
Q
What are some non-pharmacological options for pain relief during labour (3)?
A
- Birthing pool
- Relaxation techniques
- Aromotherapy
24
Q
What are some medical options for pain relief during labour (4)?
A
- Paracetamol/ codeine
- Entonox (gas + air = 50/50 NO and O)
- IM opioids (e.g. diamorphine)
- Epidural
25
Where is an epidural carried out?
L3-4 epidural space (acts on nerve roots)
26
What medication is used in an epidural?
Bupivacaine + fentanyl
27
What are some adverse effects of an epidural (6)?
* Hypotension
* Motor weakness
* Nerve damage
* **Prolonged second stage** + increased likelihood of instrumental delivery
* Headache after insertion
* Urine retention
28
What score can be used to determine whether to induce labour?
Bishop score
29
What are the criteria included in the bishop score (5)?
* **C**onsistency (cervix)
* **D**ilation
* **E**ffacement
* **F**oetal station (how much engaged)
* **P**osition (cervix)
*CEDFP*
30
What do different bishop scores mean (3)?
* 1-5 = unripe, inaction needed
* 6-7 = intermediate
* 8-13 = ripe, likely to spontaneously deliver
31
What are ways to induce labour (5)?
* Membrane sweep
* Vaginal prostaglandin E2/ misoprostol (oral prostaglandin E1)
* Amniotomy (breaking waters)
* Balloon catheter
* Oxytocin infusion
32
When is a membrane sweep typically performed?
41 week antenatal visit
*nulliparous also at 40w*
33
How should a bishop score of 1-6 be managed (2)?
* Vaginal prostaglandins
*or*
* Oral misoprostol
34
How should a bishop score of 7-13 be managed (2)?
* Amniotomy
*and*
* IV oxytocin (e.g. syntocinon)
35
What are some infections for induction of labour (4)?
* Prolonged labour
* Prolonged pregnancy
* PPROM
* Maternal GDM, pre-eclampsia, obstetric cholestasis
36
What is the main complication of induction of labour?
Uterine hyperstimulation:
* Foetal ischemia
* Uterine rupture
37
What are the categories of c-sections?
1. Immediate threat to life - deliver within 30 min
2. Not an imminent threat to life - deliver within 75 min
3. Mother and baby are stable - deliver soon
4. Elective c-section
38
What are some indications for an elective c-section (6)?
* Previous c-section (2 c-section = contraindication for vaginal)
* Placenta praevia
* Vasa praevia
* Breech
* Multiple pregnancy
* Herpes/ HIV
39
How is a c-section performed (2)?
* Joel-cohen incision = straight transverse incision
* Classical incision = midline
40
What are the layers of the abdomen that need to be directed for a c-section (7)?
* Skin
* Subcutaneous tissue
* Rectus sheaf/ fascia
* Rectus abdominis
* Peritoneum
* Uterus
* Amniotic sac
41
What are some complications of c-sections (3)?
* VBAC (vaginal birth after c-section) --> uterine rupture
* PPH
* Endometritis
42
What risk is associated with classical c-section incision?
Uterine rupture if vaginal birth after c-section (VBAC)
43
What are the two instrumental deliveries?
* Ventouse delivery
* Forceps delivery
44
What are some complications of ventouse delivery for the foetus (3)?
* Caput succedaneum
* Cephalohaematoma
* Subgaleal haematoma (even worse)
45
What is a complication of a forceps delivery for the foetus?
CN 7 palsy (facial paralysis)
46
What are some indications for instrumental delivery (3)?
* Failure to progress
* Foetal distress
* Maternal exhaustion
47
What is a key risk factor for needing an instrumental delivery?
Epidural
48
What are some risks to the mother from an instrumental delivery (4)?
* PPH
* Perineal tears
* Incontinence
* Nerve injury
49
What is PPROM vs PROM (2)?
* Preterm premature ROM = before 37 weeks and not directly preceding labour
* Premature ROM = not directly preceding labour but after 37 weeks
50
What are two prophylactic options for the prevention of preterm labour (2)?
* Vaginal progesterone
* Tocolytics (reduce uterine contractions)
* Cervical cerclage (stitch in cervix)
*can be offered when cervical length is short on USS*
51
What are some causes of PPROM (5)?
* TORCH infections
* Trauma
* CVS/ amniocentesis
* BV
* LLETZ
52
How can PPROM be investigated if there is doubt over whether the membranes have ruptured (3)?
* Sterile speculum = fluid pooled in posterior fornix
* USS = oligohydramnios
* IGF-1/ PAMG-1 tests
53
How should PPROM be managed (3)?
* Erythromycin for 10 days
* Steroids + MgSO4
* Induction (from 34 weeks)
54
What is cord prolapse?
When the umbilical cord presents before the foetus
55
What are some risk factors for cord prolapse (4)?
* **Abnormal foetal lie**
* Polyhydramnios
* ARM (artificial rupture of membranes)
* Multiple pregnancies
56
What are the signs/ symptoms of prolapsed cord (3)?
* Foetal bradycardia
* Visible cord
* Felt on vaginal exam
*speculum exam can confirm*
57
How is a cord prolapse managed (2)?
* Immediate c-section
* Go on all 4s + catheterise (reduces pressure on cord)
58
What medications can be used to manage cord prolapse?
Tocolytics e.g. terbutaline
*minimise contractions*
59
What are some compilations of a cord prolapse (2)?
* Foetal ischemia
* Nuchal cord (wraps around babies neck)
60
What are the types of breech presentation (3)?
* **Complete** = flexed at hips and knees
* **Frank** = flexed at hips, extended at knees
* **Footling** = 1 foot hangs down
61
What can be used to treat breech presentations?
External cephalic version
62
When is external cephalic version done?
37 weeks
*can do at 36 weeks if first time*
63
What are some risk factor for breech presentation in labour (2)?
* Polyhydramnios
* Prematurity
64
What are some risks associated with breech position (3)?
* **DDH**
* Hypoxic ischemic encephalopathy
* Uterine rupture
65
What are the ways the "position" of a foetus is described in the womb (5)?
* Lie
* Presentation
* Position
* Attitude
* Station
66
What are the 3 types of lie of a foetus?
* Longitudinal (parallel to mothers spine)
* Transverse (perpendicular to mothers spine)
* Oblique (diagonal)
67
What are the 3 presentations of a foetus?
* Cephalic (head)
* Breech (bum/ feet)
* Shoulder
68
How is the position of the presenting part described (2)?
* Right/ left
* Anterior/ posterior
*in relation to occiput/ sacrum of foetus*
69
How is the attitude of the foetus described (2)?
* Flexed
* Extended
70
What is the station of the foetus?
How far descended into the pelvis the foetus is (fifths engaged)
71
What are the types of perineal tears (4)?
* First degree = mucosa
* Second degree = muscle
* Third degree = anal sphincter
* Fourth degree = rectal mucosa
72
How are perineal tears managed (3)?
* First = northing
* Second = midwife stitch
* Third/ fourth = theatre stitching
73
What are some risk factors for perineal tears (5)?
* First birth
* Large baby
* Shoulder dystocia
* Instrumental deliveries
* Occipito-posterior lie
74
What is an obstructed labour?
Mechanical obstruction to the descent of the baby
75
How can an obstructed labour be treated?
Episiotomy (cut down the perineam and around the anal sphincter)
76
What can sometimes happen if the babies head is large?
Cephalopelvic disproportion = babies head is too large to fit through the mothers pelvis
77
What is it known as when the anterior shoulder of the baby gets stuck on the pubic symphysis?
Shoulder dystocia
78
What is a common cause of shoulder dystocia?
Macrosomia due to GDM
79
How does shoulder dystocia present?
Head delivers but shoulders then become stuck and won't come out
80
How is shoulder dystocia managed (3)?
* **McRoberts manoeuvre** = flex hips (bring knees to abdomen)
* Pressure to anterior shoulder
* Zavanelli manoeuvre = push babies head into uterus to allow for c-section
81
What are some complications of shoulder dystocia (4)?
* Foetal hypoxia
* Erbs palsy
* Perineal tears
* PPH
82
What is Erbs palsy?
Injury to brachial plexus
83
What is the position of the arm in Erbs palsy?
Internal rotation of the arm with flexion of wrist + hand/ fingers
84
What are the types of PPH in terms of time frame (2)?
* Primary < 24 hours
* Secondary 24 hours - 6 weeks
85
What are the severities of PPH (3)?
* Minor 500-1000ml
* Moderate 1000-2000ml
* Severe > 2000ml
*c-section > 1000ml = PPH*
86
What are the causes of PPH (4)?
* **T**one (decreased pressure on spiral arteries) = mc
* **T**issue (retained products)
* **T**hrombin (DIC)
* **T**rauma (tears, uterine rupture)
87
What are some risk factors for PPH (6)?
* Prolonged labour
* Phx c-section
* Polyhydramnios
* Twins
* Fibroids
* Multiparity
88
How is PPH managed (3)?
* Fundal massage + catheterise
* IV oxytocin
* Intrauterine balloon tamponade + compression sutures
89
How is retained tissue of conception managed?
Surgical D+C
90
What are some complications of PPH (3)?
* Sheehans syndrome
* DIC
* Shock --> death
91
What risk to the mother should be assessed at the time of birth?
VTE risk assessment (more than 4 risk factors = high risk)
92
How should women at high risk of DVT be managed after giving birth?
LMWH for 6 weeks
93
What is a common infection that occurs in women after childbirth (especially c-sections)
Endometritis
94
How does endometritis after pregnancy present (4)?
* Fever (>38)
* Lower abdo pain
* Offensive discharge
* Bleeding
95
How soon after birth does endometritis usually present?
Within 72 hours
*although can present weeks after*
96
What bacteria commonly cause endometritis after pregnancy (2)?
* GBS
* E. coli
*other KEEPS bacteria*
97
How is endometritis after pregnancy investigated?
* Blood cultures
* Vaginal swabs
* TVUSS
98
How should endometritis after pregnancy be managed?
IV clindamycin + gentamicin
99
What conditions can affect the mental health of women who have recently given birth (3)?
* Baby blue
* Postpartum depression
* Postpartum psychosis
100
When should baby blues resolve within?
2 weeks of delivery
*peaks in first week*
101
How common are baby blues?
More than 50% of women
102
What are the signs/ symptoms of baby blues (4)?
* Low mood
* Mood swings
* Tearful
* Anxiety
103
How should baby blues be treated?
No treatment needed
104
How long should postnatal depression last before being diagnosed?
2 weeks
105
What are the signs/ symptoms of postnatal depression (3)?
* Anhedonia
* Low mood
* Anergia
*same as depression*
106
What criteria can be used to diagnose postnatal depression?
Edinburgh scale
107
How should postnatal depression be managed (3)?
* Self help
* CBT
* SSRIs (sertraline)
108
What are the signs/ symptoms of puerperal psychosis (5)?
* Delusions
* Auditory hallucinations
* Severe mood swings
* Thoughts to harm baby
* Depression
109
How is puerperal psychosis managed (4)?
* Admit to mother + baby ward
* CBT
* Medications
* ECT
110
