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A - MSRA Obstetrics [16] > [35] Management of Labour > Flashcards

[35] Management of Labour Flashcards

1
Q

What is the primary aim of intrapartum care?

A

To deliver a healthy baby to a healthy mother

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2
Q

When does the preparation of the mother for the process of parturition begin?

A

Well before the onset of labour

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3
Q

What is it important for the mother and her partner to understand regarding labour?

A

What happens during the various stages of labour

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4
Q

How should the mother be prepared for labour during antenatal classes?

A

Should be introduced to strategies for dealing with pain in labour, including mental preparation with controlled respiration

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5
Q

How can antenatal classes help the mother with life with a baby?

A

Should include instructions about neonatal care and breastfeeding

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6
Q

When should the mother be advised to come to hospital (or call the midwife in the event of a home birth) with labour?

A
  • Contractions are at regular 10-15 minute intervals
  • When there is show
  • Membranes rupture
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7
Q

What should the mother be encouraged to do if she is in early labour?

A

Take a shower and empty her bowels and bladder

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8
Q

What should be done on admission of women in labour?

A

Examination

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9
Q

What should be included in the examination at the start of labour?

A
  • Full general examination
  • Obstetric examination of the abdomen
  • Vaginal examination
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10
Q

What should be included in full general examination at the start of labour?

A
  • Temperature
  • Pulse
  • RR
  • BP
  • State of dehydration
  • Urine testing
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11
Q

What should the urine be tested for at the start of labour?

A
  • Glucose
  • Ketones
  • Protein
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12
Q

What should be included in obstetric examination of the abdomen at the start of labour?

A
  • Inspection
  • Palpation
  • Auscultation of fetal heartbeat
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13
Q

What should be palpated in the abdominal examination at start of labour?

A
  • Fetal lie
  • Presentation
  • Position
  • Station of presenting part
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14
Q

How can the fetal heartbeat be auscultated at the start of labour?

A

Using stethoscope or Doptone device

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15
Q

How can infection be prevented when doing the vaginal examination at the beginning of labour?

A
  • Clean vagina and introitus before starting
  • Use aseptic technique, using sterile gloves and antiseptic cream
  • Once examination has started, fingers should not be withdrawn from vagina until examination is complete
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16
Q

What factors need to be noted at the examination at the beginning of labour?

A
  • Cervical factors
  • Membrane factors
  • Fetal factors
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17
Q

What should be noted about the cervix from the examination at the start of labour?

A
  • Position
  • Consistency
  • Effacement
  • Dilatation of cervix
18
Q

What should be noted about the membranes from the examination at the start of labour?

A

If they are in tact or ruptured, and if ruptured, the colour and quantity of amniotic fluid

19
Q

What should be noted about the fetus from the examination at the start of labour?

A
  • Presentation
  • Position of presenting part
  • Relationship of presenting part to level of ischial spines
20
Q

What are the guiding principles of the management of first stage of labour?

A
  • Observation of the progress of labour, and intervention if its slow
  • Monitoring of fetal and maternal condition
  • Pain relief during labour and emotional support for the mother
  • Adequate hydration and nutrition throughout labour
21
Q

How is observation of the progress of labour done?

A

Using the partogram

22
Q

How is monitoring of the fetal and maternal condition done?

A

Partogram

23
Q

What needs to be balanced when considering hydration and nutrition throughout labour?

A

The risk of needing a C-section vs providing hydration and nutrition

24
Q

What should be done when there is a likelihood that the mother will need operative delivery under general anaesthesia?

A

Avoid oral intake of a significant level during the first stage of labour

25
Q

Why should you avoid significant fluid intake during the first stage of labour if operative delivery is likely?

A

Because delayed gastric emptying may result in vomiting and inhalation of vomit if general anaesthesia for operative delivery is required

26
Q

How are most operative deliveries performed?

A

Under regional anaethesia

27
Q

What is the result of most operative deliveries being performed under regional anaesthesia, with respect to nutrition?

A

There is a case for giving fluids and light nutritional orally if labour is progressing normally, and vaginal delivery can be anticipated

dont think this really makes sense but oh well lol

28
Q

When should IV fluids be given in labour?

A

6 hours into labour, if delivery is not imminent

29
Q

Why is it important to manage hydration in labour?

A

Dehydration is a major cause of acidosis and ketosis

30
Q

How should dehydration be checked for during labour?

A

Urine should be checked for ketones in addition to sugar and protein whenever the mother passes urine

31
Q

How can the duration of placental separation in the third stage of labour be compressed?

A

Using oxytocic drugs administered at the delivery of the anterior shoulder

32
Q

What is the placenta accompanied by as it is expelled?

A

The fetal membranes

33
Q

What might happen to the fetal membranes as they are expelled?

A

They often become torn

34
Q

What is required if the fetal membranes become torn as they are expelled?

A

May require additional traction using sponge forceps

35
Q

What is rarely needed to complete the removal of the fetal membranes?

A

Uterine exploration

36
Q

When do most complications of labour and delivery occur?

A

Within the first few hours of delivery

37
Q

What complications can occur within the first few hours of delivery?

A
  • Post-partum haemorrhage
  • Pelvic or perineal haematoma
  • Deterioration of the maternal or newborn condition
38
Q

What is done because of most complications of labour and delivery occurring within the first few hours after delivery?

A

Mother and baby are closely examined with periodic observations in the delivery unit for up to 2 hours

39
Q

What happens after the mother and baby have been observed on the delivery unit?

A

They are sent to the postnatal ward

40
Q

How long are observations continued on the postnatal ward after delivery?

A

6 hours

A - MSRA Obstetrics [16] (61 decks)

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