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J Repro > Childbirth > Flashcards

Childbirth Flashcards

1
Q

another name for childbirth

A

partuition

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2
Q

which hormone increased contractility (2)

A

oestrogen

oxytocin

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3
Q

which hormone decreases contractility

A

progesterone

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4
Q

what change in the cervix causes oxytocin release

A

cervix stretch

= oxytocin release = increase contractions

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5
Q

what does oxytocin make the uterine wall release

A

prostaglandins

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6
Q

what happens to the interval of contractions over time

what does it end up as in true labour

A

gets shorter and shorter

ends up 3-4 in 10mins

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7
Q

what happens to length of contraction over time

what does it end up as in true labour

A

increases over time

45seconds

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8
Q

what are Braxton hicks contractions

when do they occur

A

‘false labour’
occur towards the end of pregnancy
not as strong as real contractions

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9
Q

what resolves Braxton hicks contractions

A

lying down

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10
Q

which stage of labour to the waters break in

A

any stage!

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11
Q

what is normal blood loss during labour

A

<500ml

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12
Q

what happens during stage 1 of labour

A

cervical dilatation

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13
Q

what is the end point of stage 1 of labour (how can you tell)

A

10cm dilated

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14
Q

up to what dilatation is the latent phase of stage 1 of labour

A

<4cm dilatation

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15
Q

up to what dilatation is the active phase of stage 1 of labour

A

4-10cm dilatation (full dilatation)

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16
Q

which part of stage 1 of labour (latent or active) is the descend of the presenting part

A

active stage 1 (full dilatation also occurs here)

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17
Q

what is stage 2 of labour

A

passage through the birth canal

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18
Q

how long does stage 1 of labour normally last

A

8-24 hours

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19
Q

how long does stage 2 of labour normally last

A

0-120 mins

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20
Q

what is classed as prolonged stage 2 of labour in a nulliparous woman (this is her first child)

A

> 3 hours with analgesia

or >2 hours without analgesia

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21
Q

what is classed as prolonged stage 2 of labour in a multiparous woman (this is not her first child)

A

> 2 hours with analgesia

or >1 hours without analgesia

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22
Q

what is stage 3 of labour

A

expulsion of placenta

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23
Q

what happens to the uterus in stage 3 of labour just before the placenta is expulsed

A

it hardens and contracts

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24
Q

what is usually given to mums to induce stage 3 of labour

A

oxytocin

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25
Q

what method can be used to help ease the placenta out during stage 3 of labour

A

cord traction

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26
Q

how long after birth of baby does stage 3 usually happen

A

3-10 mins

>1 hour abnormal

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27
Q

if after 1 hour placenta hasn’t came out, what do you do

A

surgery to remove it

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28
Q

what does bishops score assess

A

likelihood of woman going into labour

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29
Q

what does partogram assess

A

progress of labour

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30
Q

normal fetal heart rate

A

120-160

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31
Q

if meconium in liquor (amniotic fluid) what should you check

A

if breech

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32
Q

at station 0 what orientation should the babies head be in

A

occiput-anterior

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33
Q

what is the normal rate of descent of presenting part

A

1cm/hour

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34
Q

what dilatation of the cervix is full dilatation

A

10cm dilatation

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35
Q

how many contractions per 10 mins is normal

A

3-4

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36
Q

what is a cardiotograph used for

A

to assess fetal distress

37
Q

how do you interpret a cardiotograph (mneumonic)

A

DR C BRAVADO

Define Risk 
Contractions 
Baseline RAte
Variability 
Acceleration 
Deceleration 
Overall
38
Q

in CTG how do you ‘Define Risk’

A

any risk factors for fetal distress eg prolonged labour

39
Q

in CTG what is normal Contraction rate

A

3 in 10 mins

40
Q

in CTG what is normal Baseline RAte

what is abnormal

A

average fetal heart rate

120-160
>160 tachycardic
<120 bradycardic

41
Q

in CTG how do you measure Variability

what is normal

A

diff between highest and lowest values (hr)

normal variation = 5-25bpm

42
Q

in CTG how do you measure Accelerations

A

are there any abnormally high peaks??

43
Q

in CTG how do you measure Decelerations

A

are there any abnormally low peaks??

44
Q

what is the line at the top of the graph in CTG

what is the line at the bottom of the graph in CTG

A

fetal heart rate

contractions (peaks are contractions)

45
Q

what are the 3 possible causes of problems in labour

A

3Ps
passage -pelvis too small/wrong shape (eg android)
passenger - babys head too big
power - reduced/inadequate uterine contraction

46
Q

sign on the babys head that the head is too big or the passage (pelvis) is too small (2)

A

caput - swelling in scalp through fontanelles

moulding - when the skull bones overlap (via fontanelles)

47
Q

5 components of vaginal exam during labour

A 
effacement 
dilatation 
firmness
fetal head position 
station
48
Q

which examination tells you the lie of the baby

what is the lie of the baby
what are the 3 options

A

abdo exam

where the baby is lying in respect to longitudinal axis

options; longitudinal (normal), transverse (diagonal), oblique

49
Q

if the presenting part of the baby is the vertex, what is the presentation of the baby

A

cephalic (normal)

50
Q

if the presenting part of the baby is the bottom/arm/shoulder, and the head is felt in the upper abdomen, what is the presentation of the baby

A

breech

51
Q

what is the normal fetal head position when above the ischial spines (ie -ve station, going through pelvic inlet)

A

right/left occipito transverse

52
Q

what is the normal fetal head position when below the ischial spines (ie +ve station, going through the pelvic outlet)

A

occipitoanterior

53
Q

how do you figure out station of baby

A

how many cm biparietal diameter is above/below the ischial spines

54
Q

7 cardinal movements

A 
engagement 
descent 
flexion -chin to chest
internal rotation 
crowning and extension - when exiting vagina
restitution and external rotation 
expulsion of rest of body
55
Q

how do you measure engagement

A

how many /5 are in pelvis

56
Q

most common form of analgesia

who can give it

A

Entonox - gas and air

can be given by midwives

57
Q

if Entonox (gas and air) not effective, what is the next best option of pain relief in labor

A

epidural anaesthesia

58
Q

what does an epidural anesthesia numb

A

everything below T12 - cant feel what theyre doing when pushing

59
Q

side effects of epidural anesthesia

A

hypotension

60
Q

alternative to epidural anaesthesia

A

diamorphine - uncommon

61
Q

which layers do you go through when administering an epidural anaesthesia

which layer do you end up in

A

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space

  • end up in epidural space
62
Q

which layers do you go through when administering spinal anaesthesia

which layer do you end up in

A 
supraspinous ligament 
interspinous ligament 
ligamentum flavum 
epidural space
dura mater 
arachnoid mater
subarachnoid mater
  • end up in subarachnoid space
63
Q

which nerve level do you administer epidural/spinal anaesthesia

A

L3/4

64
Q

what position must you administer spinal anaesthesia in

A

standing/sitting (NOT lying down as can go to head and increase ICP = headache)

65
Q

what does spinal aneasthesia do

A

blocks all sympathetic flow from nerves below L2 eg pudendal, femoral, sciatic, obturator

= VASODILATION of lower limbs
also hypotension

66
Q

which one causes headache - spinal or epidural anaesthesia

A

spinal anaesthesia

67
Q

where does a pudendal nerve block innervate

A

perineum only (not anterior labia)

68
Q

how do you find pudendal nerve is doing a pudendal nerve block

A

feel for ischial spines (4 and 8 oclock positions), travels round ischial spine

69
Q

when is a perineal nerve block used

A

episiotomy incision
forceps delivery
painful vaginal delivery
perineal stitching post delivery

70
Q

if fetal distress and you do fetal blood sampling, what pH is abnormal

what do you do

A

<7.20 abnormal = DELIVER baby

71
Q

if abnormal labour (fetal distress or failure to progress) what are your options (3)

A

episiotomy
operative vaginal delivery - forceps or ventouse (suction)
c section

72
Q

if doin episiotomy, which direction do you cut

A

mediolateral into ischioanal fossa

73
Q

why don’t you cut straight down in episiotomy

A

bc if the cut tears further = goes into rectum/anal sphincter

74
Q

requirements for forceps/ventouse delivery (dilatation and engagement)

A 
full dilatation (10cm) -  if 9cm needs c section 
2/5s descent - if higher needs c section
75
Q

indications for c section delivery (over forceps/ventouse) if failure to progress in labour (4)

A

not full cervical dilatation (eg 9cm or below)
>2/5 engagement
breech
maternal request

76
Q

indications for induction of labour

A

pre eclampsia
antepartum haemorrhage - eg placenta praveia, placental abruption
post dates pregnancy

77
Q

what 2 drugs can be used to induce labour

A

prostaglandins

IV syntocinon

78
Q

what method can be used to artificially break someones waters (rupture their membranes)

A

amniotomy

79
Q

what can immediate cord clamping cause

how do you prevent this

A

decreased RBC = anaemia
want to allow them to get as much as possible from the placenta

delay cord clamping

80
Q

what do you recommend mum to do immediately after birth

A

skin to skin contact for 1 hour

81
Q

who repairs a 1st or 2nd degree vaginal tear/episiotomy

A

midwife

82
Q

who repairs a 3rd or 4th degree vaginal tear/episiotomy

A

obstetrician - need pudendal nerve block

83
Q

which vitamin is given within minutes of delivery

given via..

why

A

vitamin K IM

to prevent haemorrhagic disease of the newborn

84
Q

which vaccination is usually given at 2 months old, but is given immediately if the mum is known to be affected

A

hep B vaccination

85
Q

what 4 screening tools are used in newborns

A

top to toe exam at birth
newborn assessment - from dr between 6-24 hours
universal hearing screening test
blood spot (Guthrie card)

86
Q

what is the blood spot/gurthrie card/new born screening card used to test for (4)

A

cystic fibrosis
hypothyroidism
haemoglobinopathies eg sickle cell
6 metabolic things eg PKU

87
Q

how does spinal anaesthesia cause hypotension

A

blockade of sympathetics to blood vessels = vasodilation

88
Q

treatment of hypotension caused by spinal anaesthesia

A

ephedrine (=release of noradrenaline = sympathetics to blood vessels = increases bp)

J Repro (28 decks)

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