Child birth Flashcards
Preterm is birth before how many weeks?
37 weeks
Term is birth at what week gestation?
37-42 weeks
Post term is how many weeks gestation?
42wks–>
What is the lie?
The relation of the longitudinal axis of the focus to the longitudinal axis of the uterus
TRUE/FALSE
The foetus is engaged if the widest leading part has passed through the pelvic inlet
TRUE
What is labour?
The Physiological process during which the foetus, membranes, umbilical core and placenta are expelled from the uterus
Labour is associated with regular, painful contractions with increasing frequency and intensity TRUE/FALSE
TRUE so true
uterus excitability is due to
Oestogen and oxytocin
Myometrial stretch increases the —- of myometrial fibres
Excitability
Mechanical stretch of cervix and stripping of the fetal membranes causes further —— release
Oxytocin
What is Fergusons reflex?
Self-sustaining cycle of uterine contractions initiated by pressure at the cervix or vaginal walls- positive feedback
Which hormone initiates and sustains contractions?
Oxytocin
What is the purpose of the liquor?
nourishes and protects fetus and facilitates movement
If meconium is thick and heavy what is the baby at risk of?
Aspiration
What is the cervical tissue made of?
Collagen tissue (types 1-4)
Smooth muscle
Elastin
Held together by connective tissue
Cervical softening is caused by what?
An increase in hyaluronic acid
What does Bishops score determine?
If it is safe to induce labour
What bishops score indicates that she is ready for labour?
> 8
What is the first stage of labour divided up into?
Latent stage
Active stage
Describe the latent stage of labour?
up to 3-4cm dilated
mild irregular uterine contractions
Cervix softens and shortens
duration variable-may last a few days
What are the stages of labour?
First- Divided into latent and active stage
Second
Third
Describe the active stage of labour
4cm-10cm (full dilation)
slow descent of presenting part
contractions more rhythmical and stronger
What is the normal rate of progression for the active stage of labour?
1-2cm per hour
What happens in the second stage?- from when to when
Full dilation –> Delivery of the baby
When is the second stage considered prolonged?
No babies- 3h+ with analgesia (2+ without)
If babies- 2h+ with analgesia (1+ without)
What is the third stage of labour?
Delivery of baby–> Expulsion of the placenta and membranes
How long should the third stage take?
3-30m (average 10m)
What is the active management of the third stage?
Oxytocic drugs - syndometerine 1ml or Oxytocin 10 units
Controlled cord traction
Name the 3 signs of separation
1- Uterus contrast, hardens and rises
2-Umbilical cord lengthens permanently
3-Gush of blood (not always, variable in amount)
What is the plan of separation?
Spongy layer of the decider basalis
What is the normal level of blood loss?
<500mls
Haemostasis is achieved by which 3 things:
1-Tonic contraction
2-Thrombosis of the torn vessel ends
3-Myo-tamponade
When are Braxton hicks commonly?
can start 6wks into pregnancy, usually in 3rd trimester
What differentiates Braxton hicks contractors from labour contractions?
They are irregular and do not increase in frequency or intensity
What is the name of the contractions tightening the top of the uterus pushing the baby downward into the birth canal in preparation?
Fundal dominance
What is the most suitable type of pelvis?
Gynaecoid
What is the pelvis type that most African-carribean women have?
Android
What are the 5 parameters of cervical assessment:
Effacement Dialtion Firmness Position Station
What is the best analgesic to use?
Entonox
but makes some women feel sick, strange euphoric feeling
What is the transverse diameter at the pelvic inlet?
13cm
What is the AP diameter at the pelvic outlet?
13cm
What are the 7 cardinal movements of labour
- Engagement
- Descent
- Flexion
- Internal Rotation
- Crowning and extension
- Restitution and external rotation
- Expulsion
When the largest diameter of fatal head is enriched by the vulval ring what will the mother feel?
Burning and stinging feeling
Benefit of delayed cord clamping
Higher RBC flow to vital organs in 1st week
Less anaemia at 2months
What are the benefits of skin to skin contact
Bonding
Breast feeding rates increase
How long is it to the return of tissues to a non-pregnant state?
~6 weeks
How long does it take post pregnancy for the endometrium to regenerate?
End of a week
except the placental site
What is the length of a good contraction/
30s
What are the 3 types of breech presentation?
Complete breech
Footling breach
Frank breach
What is the aetiology of labour pain?
Compression or para-cervical nerves/myometrial hypoxia
What is the drug used in epidural?
Levobupivacaine +- Opiate
What does a partogram measure?
Fetal heart amniotic fluid cervical dilation descent contractions obstruction-moulding maternal observations
What drug can be given if there is failure to progress?
Synthetic oxytocin
What are 3 ways of intra-partum petal assessment?
Doppler auscultation of fetal heart
Electronic fetal monitoring- Cardiotocograph (CTG)
Colour of amniotic fluid
What is vasa previa?
A condition where the fatal blood vessels cross or run near the internal opening of the uterus
What pH on fatal sampling would indicate that the baby needed to be delivered?
<7.20
Decelerations are reassuring TRUE/FALSE
FALSE
What fatal HR is counted as tachycardia?
> 150
What are the causes of a collapses obstetric patient?
4Hs and the 4Ts
Hypoxia, Hypovolaemia, Hyperkalaemia/Hypokalaemia, Hypothermia
Tablets/toxins, tamponade, tension pneumothorax, thrombosis
The uterus compressing IVC and aorta leads to …. …..
Supine hypotension
How is aortocaval compression reversed?
Turning the lady onto her left lateral position
In chest compression in non pregnant women it achieves around 30% of normal CO, in pregnant women how much is this reduced?
Further reduced CO by around 10%
Define Small for gestational age
Estimates fatal weight or abdominal circumference below the 10th centile
What is polydramnios?
Excess amniotic fluid (AFI >25)
Management of diabetes in pregnancy?
Aim for 48mmol/mol
stop embryopathic medication e.g. ACEi
5mg folic acid and aspirin pre conception
At what HbA1c would you advise them to not get pregnant?
86mmol or more
When can the USS confirm that it is indeed a multiple pregnancy?
12wks
