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repro > child birth > Flashcards

child birth Flashcards

1
Q

different types of breech presentation

A

complete breech - legs folded with feet at level of babys bottom

footling breech - one or both feet point down so the legs would emerge first

frank breech - legs point uo with feet by babys head so bum emerges first

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2
Q

brow bresentation

A

head extented instead of flexed (can see brows)

step before face presentation

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3
Q

epidural anaethesia + complications

A

effective - complete pain relief in 95%
does not impair uterine activity
levobupivacaine +/- opiate

complications
- hypotension
- dural puncture
- headache
- high block
- atonic bladder

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4
Q

epidural facts

A
  • Only available in obstetric units
  • More effective than opioids
  • Not assoc with long term backache
  • Not assoc with longer first stage of labour
  • Does not increase C-section chance
  • Assoc with longer 2nd stage of labour**
  • Slightly increased chance of operative birth
  • Accompanied by a more intensive level of monitoring
  • Requires IV access
  • Mobility may be reduced
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5
Q

who is failure to progress in labour more likely in

A

nulliparous

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6
Q

signs of obstruction

A

moulding of skull
caput - swelling/lump on heaf
anuria
haematuria
vulval oedema

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7
Q

obstructed labour risks

A

sepsis
uterine rupture
obstructed AKI
PPH
fistula formation
fetal asphyxia
neonatal sepsis

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8
Q

suspected delay in stage 1

A

Nulliparous - <2cm dilation in 4hrs

multiParous - <2cm dilation in 4hrs or slowing in progress

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9
Q

intra-partum fetal assessment

A

Stage 1
- During and after a contraction
- Every 15mins

Stage 2
- At least every 5 mins during + after a contraction for 1 whole minute + check Mat pulse at least every 15mins

  • Electronic fetal monitoring – cardiotocograph (CTG)
  • Colour of amniotic fluid
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10
Q

causes of fetal hypoxia

A

acute
- uterine hyperstimulation
- abruption
- cord prolapse
- uterin rupture
- feto-maternal haemorrhage
- regional anaesthesia
- vasa praevia

chronic
- placental insufficienct
- fetal anaemia

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11
Q

fetal hypoxia on CTG

A

loss of acceleration
repetitive deeper + wider deceleration
rising fetal baseline heart rate
loss of variability

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12
Q

management of abnormal CTG

A

change maternal position
IV fluids
stop syntocinon
scalp stimulation
consider tocolysis - terbutaline
maternal assessment
consider fetal blood sampling - from skull
operative delivery

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13
Q

fetal scalp blood pH

A

> 7.25 - normal

7.20-7.25 - borderline -> repeat 30min

<7.20 - abnormal ->deliver

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14
Q

operative delivery, what prophylactic antibiotic is required after?

A

vaginal delivery assisted by either a ventouse suction cup or foreceps

single dose of co-amoxiclav is recommended after to reduce risk of maternal infection

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15
Q

indications for operative deliveries

A

“standard” indications
o Delay – failure to progress stage 2
o Fetal monitoring concern
“special” indications
o Maternal cardiac disease
o Severe PET/eclampsia
o Intra-partum haemorrhage
o Umbilical cord prolapse stage 2
(each case considered individually)
(ZTF)
failure to progress
fetal distress
maternal exhaustion
control of head in various positions

** increased risk of requiring an instrumental delivery with epideural is in place

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16
Q

complications of operative deliveries to mum

A

PPH
episiotomy
perianal tears
injury to anal sphincter
incontinence of bladder or bowel
nerve injury - obturator, femoral

17
Q

complications of operative deliveries to baby

A

cephalohaematoma ->ventouse (suction cup)

forceps
- facial nerve palsy
- bruises
- fat necrosis - hardened lumps of fat on cheeks, resolves over time

others
- subgaleal haemorrhage - most dangerous
- intracranial haemorrhage
- skull fracture
- spinal cord injury

18
Q

nerves at risk of injury in operative delivery

A

femoral
obturator

usually resolves over 6-8wks

19
Q

what effects would damge to the femoral nerve cause

A

(may be compressed against inguinal canal during forceps delivery)

  • weakness of knee extension
  • loss of patella reflex
  • numbness of anterior thigh + medial lower leg
20
Q

what effects would damge to the obturator nerve cause

A

(may be compressed by forceps during instrumental delivery or fetal head during normal)

  • wekness of hip abduction + rotation
  • numbness of medial thigh
21
Q

duration of stage 2 in prims vs multips

A

prim - no epidural 2hr, epidural 3hr

multips - no epidural 1hr, epidural 2hr

22
Q

pain relief in labour

A

non-medical - changing position, water births, tens machines in early stages
simple analgesia - paracetamol, codeine (NO NSAIDS)
gas+air (entonox)

IM pethidine or diamorphine (see complications)
epidural

23
Q

IM pethidine or diamorphine during labour

A

opioid medications given via IM injection

mother -> drowsiness, nausea
neonate -> respiratory distress if given too close to birth, may make first feed more difficult

24
Q

epidural

A

Local anaesthetic into epidural space
- Diffuse to surrounding tissue + into spinal cord

Anaesthetic options – levobupivacaine, bupivacaine usually mixed with fentanyl

indwelling catheter required
Contraindicated in coagulopathies

25
Q

adverse affects of epidural anaesthetic

A

headache after insertion
hypotension
motor weakness
nerve damage
prolonged 2nd stage
increased probability of instrumental delivery
epidural haematoma

26
Q

what is recorded on a partogram

A

(used to monitor progress in first stage of labour)

  • cervical dilatation - measure by 4hrly vaginal exam
  • descent of fetal head - in relation to ischial spines
  • maternal pulse, BP, temp + urine output
  • fetal heart rate
  • frequency of contractions
  • status of membranes, presence of liquor + whether liquor is stained by blood or meconium
  • drugs + fluids that have been given
27
Q

measuring uterine contractions

A

measure in contractions per 10mins

“she is contracting 2 in 10” = 2 contractions in 10mins

28
Q

what are the lines on partograms and what do they mean?

A

2 lines that indicate when labour may not be progressing adequately - labelled “alert” + “action”
- the dilation of cervix is plotted against duration of labour (time)
-* when it takes too long for cervix to dilate, the reading will cross to the right of the laert + action lines

crossing alert line -> indication for amniotomy (artifically rupturing membranes) + repeat exam in 2hrs
crossing action line -> care needs to be escalated to obstetric-led care

29
Q

tocolysis

A

drugs used during pregnancy which supress contractions + thus labour
- can only used for a few days + should not be used long term

indicated in pre-term labour to delay delivery by a few days - buy time for steroids to work/allow time to move mother to appropriate care unit

30
Q

examples of tocolysis

A

nifedipine (CCB) –> 1st line UK
atosiban (oxytocin receptor antagonist)
indomethacin (NSAID)
terbutaline (beta2agonist)

–> magnesium sulphate may be administered for its foetal neuroprotective effects

31
Q

contraindications to tocolysis

A
  • Greater than 34wks
  • Non-reassuring cardiotocograph, fatal foetal anomaly or intrauterine death
  • Intrauterine growth restriction or placental insufficiency
  • Cervical dilation <4cm
  • Chorioamnionitis
  • Maternal factors – pre-eclampsia, ante-partum haemorrhage, haemodynamic instability

Drug specific contraindications
- Eg nifedipine -> cardiac disease – severe hypotension, heart failure

repro (33 decks)

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