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Year 3- Reproduction > Caesarean Section, Foetal Monitoring in Labour and Induction of Labour > Flashcards

Caesarean Section, Foetal Monitoring in Labour and Induction of Labour Flashcards

1
Q

Two types of Caesarean section?

A

Lower uterine segment incision- most common
Classical

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2
Q

When may a classical caesarean be undertaken rather than a lower uterine segment incision?

A

Very premature foetus
Very rapid delivery required

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3
Q

Indications for caesarean section?

A

Foetal distress
Failure to progress in labour
Failed induction of labour
Malpresentation
Severe pre-eclampsia
Placenta praevia
Twin pregnancy with non-cephalic presenting twin
Repeat caesarean section

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4
Q

What are the four categories of C-section?

A

Emergency
Urgent
Scheduled
Elective

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5
Q

How quickly should an emergency C-section take place?

A

Within 30mins

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6
Q

How quickly should an urgent C-section take place?

A

Within 90mins

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7
Q

Potential complications of a C-section?

A

Injury to surrounds structures- bladder or ureters
Haemorrhage
DVTs
Infection

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8
Q

To minimise risk of complications in a C-section, what is given to the mother?

A

Prophylactic antibiotics
Low molecular weight heparin

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9
Q

Under which type of anaesthetic is a C-section typically carried out?

A

Regional anaesthesia

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10
Q

What is done to all women having a C-section to protect the bladder?

A

All women are catheterized

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11
Q

What are some of the long term increased risks on future pregnancies because of C-section?

A

Placenta praevia or accreta
Antepartum stillbirth
Uterine rupture
Post-operative adhesions => subfertility

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12
Q

Acute foetal bradycardia has been noted on CTG. Conservative measures have not led to an improvement in foetal heart rate. What is the most appropriate management option?

A. Category I Caesarean Section
B. Category II Caesarean Section
C. Category III Caesarean Section
D. Category IV Caesarean Section
E. Induction of labour

A

A- Category I Caesarean Section

->this is because there is significant foetal compromise

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13
Q

What does foetal monitoring in labour do?

A

Assesses foetal wellbeing and allows for the detection of foetal distress (hypoxia)

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14
Q

In low risk labours, how is foetal monitoring carried out?

A

Intermittent auscultation

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15
Q

In high risk labours, how is foetal monitoring carried out?

A

Cardiotocography

->aka electronic foetal monitoring

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16
Q

What is done in intermittent auscultation?

A

Doppler ultrasound
For 1 min after a contraction every:
15 mins in first stage of labour
5 mins in second stage of labour

17
Q

In intermittent auscultation, what is done is any abnormality is heard?

A

Switch to CTG instead

18
Q

What two things does CTG assess?

A

Foetal heart rate
Contraction monitor sensor

19
Q

Indications for CTG monitoring?

A

Induction of labour
Post maturity or pre-maturity
Multiple pregnancy
Underlying health condition
Antepartum or intrapartum haemporrhage
Pyrexia
Abnormal lie
Small baby for gestational age
Epidural anaesthesia

20
Q

Which underlying healthy conditions would be an indication for CTG monitoring?

A

Cardiac conditions
Diabetes
Hypertension
Pre-eclampsia

21
Q

What may be done to confirm foetal hypoxia?

A

Foetal blood testing

22
Q

A 24yo primigravida at 36wks gestation is in spontaneous labour. She is 5cm dilated and the CTG shows a foetal HR of 140bpm with a variability f >5bmp. Pregnancy has been uncomplicated and there are no underlying health conditions. However, there are some late decelerations on CTG.

What should you do next?

A. Induction of labour
B. Urgent caesarean section
C. Continue CTG monitoring
D. Foetal blood sampling

A

D. Foetal blood sampling- this way you can detect if there is any foetal hypoxia

23
Q

What is meant by induction of labour>?

A

When labour is initiated by the use of medications

24
Q

List some of the potential indications of induction of labour.

A

Hypertensive disorders
Maternal diabetes
Prolonged pregnancy
Twin pregnancy
Prelabour rupture of membranes
Foetal growth restriction or macrosomnia
Maternal request in exceptional circumstances
Previous stillbirth or in utero death
Post-dated uncomplicated pregnancy
Pre-eclampsia

25
Q

Contraindications for induction of labour?

A

Malpresentation
Placenta praevia/vasa praevia
Prolapsed umbilical cord
Foetal distress
Anatomical abnormalities e.g. pelvic tumour

Sometimes previous C-section as induction may increase risk of uterine rupture
Sometimes maternal asthma as prostaglandins can cause smooth muscle constriction

26
Q

What are some topical meds which can be used in the induction of labour?

A

Topical prostaglandin analogues e.g. misoprostol

->encourages cervical dilatation and effacement
The alternative is a balloon catheter which is favourable over prostaglandins, now considered first line

27
Q

What is an IV med used in the induction of labour?

A

IV synthetic oxytocin e.g. syntocinon

->initiates uterine contractions

28
Q

RECAP- where is oxytocin produced by the body?

A

Posterior pituitary

29
Q

What are some potential complications of induced labour?

A

Uterine hypertonicity
Foetal distress
Adverse effects of drugs- hypotension, hyponatraemia
Failed induction
C-section
Ruptured uterus

30
Q

Which of these is an indication for induction of labour?

A. Bishop’s score of 7
B. Previous induced labour
C. Uncomplicated pregnancy at 41 weeks gestation
D. Previous C-section
E. Foetal distress

A

C- Uncomplicated pregnancy at 41wks gestation

->note that Bishop’s score <5 is an indication for induction

31
Q

A 34yo pregnant female is due to have an induction of labour at 38wks gestation due to gestation diabetes. She has a Bishop’s score of 3. What is the most appropriate next step?

A. Amniotomy
B. C-section
C. IV oxytocin
D. Reassess in 12hrs
E. Vaginal prostaglandin or intracervical balloon

A

E- vaginal prostaglandin or intracervical balloon

32
Q

Amniotomy?

A

Artificial rupture of membranes- breaking the water

33
Q
A

Year 3- Reproduction (33 decks)

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