delivery Flashcards
name some of the main indications for a caesarean
previous caesarean
foetal distress
failure to progress
maternal request
breech presentation
what is the most optimal presentation for vaginal delivery
cephalic
name some maternal risk factors for malpresentation
uterine abnormalities, placenta previa, poly/oligohydramnios, previous abnormal presentation
name some foetal risk factors for malpresentation
prematurity, multiple pregnancy, foetal abnormalities
what is transverse lie
foetus is lying sideways across the uterus
what is oblique lie
foetus lies diagonally within the uterus
what is frank breech
bum down, legs near head
what is complete breach
baby in normal position, but bum down instead of head
what is PROM
amniotic sac ruptures at least one hour before contractions start
what is classed as a premature baby
before 37 weeks
what is pPROM
pre-term premature rupture of membranes
name some risk factors associated with PROM
polyhydramnios, cervical insufficiency, infection, trauma, bleeding
what does PROM stand for
prolonged (pre-labour) rupture of membranes
what is cervical insufficiency
cervix starts to dilate in the absence of uterine contractions
clinical signs of PROM
liquor pooling in the posterior fornix on speculum
oligohydramnios on ultrasound
management of pPROM
antibiotic prophylaxis, steroids, admission for minimum 48 hours, close monitoring for infection
what is a serious complication of PROM
cord prolapse
name some acute causes of foetal hypoxia
uterine hyperstimulation, abruption, cord prolapse, uterine rupture, haemorrhage, vasa previa
name 2 chronic causes of foetal hypoxia
placental insufficiency, foetal anaemia
how do we monitor baby and identify foetal hypoxia
CTG
loss of accelerations, repetitive decelerations, rising baseline heartrate and loss of variability
management of foetal hypoxia
change maternal position, stop contractions, IV fluids, scalp stimulation
definitive management for foetal distress
operative delivery
drug commonly given for tocolysis
terbutaline - stops contractions
how do we define post dates pregnancy
extending beyond 42 weeks
name the 3 main categories of management of post-dates pregnancy
expectant with increased monitoring
c-section
induction
what is the role of cervical sweep in inducing labour
naturally stimulates the production of prostaglandins
what are the 2 main types of cervical priming
mechanical with cooks balloon
vaginal prostaglandin
what is a risk associated with vaginal prostaglandin to induce labour
uterine hyperstimulation
what is failure to progress
delayed progress or slow labour
how do we define failure to progress in the first stage of pregnancy
NP: <2cm in 4 hours
MP: <4cm in 4 hours
how do we define failure to progress in the second stage of pregnancy
NP > 2 hours
MP > 1 hours
how does failure to progress definitions change if patient has been given an epidural
add an hour as epidurals might slow labour
what is obstructed labour
labour not progressing despite good contractions - must be a mechanical blockage
how can we categorise the 3 main causes of failure to progress
3P’s
power: contraction strength and frequency
passage: short mum, pelvic shape, history of pelvic trauma
passenger: big baby, malposition
name 2 foetal signs of obstruction during labour
moulding and caput
what is moulding
bones of the foetal skull start to overlap during labour
what is caput
swelling on top of baby’s head
name 3 clinical signs of of obstructed labour (maternal signs)
anuria, haematuria
vulval oedema
what can be used to assess the progression of labour
partogram
definitive management of failure to progress
operative delivery
how can we increase power during failure to progress
artificial rupture of membranes, IV oxytocin
what is the ferguson’s reflex
the more the head pushes down on the cervix during labour, the more oxytoxin released
what initiates and sustains contractions
the release of oxytocin - promotes the release of prostaglandins
what are the 2 changes that happen to the cervix during labour
softening
ripening: thins and dilates
what is the active first stage of labour
4cm onwards to full dilatation
what is active management of the 3rd stage of labour
oxytocin and controlled cord traction
what pelvic shape is most suitable for childbirth
gynaecoid
what are the 7 cardinal movements of labour
engagement
descent
flexion
internal rotation
crowning and extension
restitution and external rotation
expulsion
what is used to determine whether it is safe to induce labour - and what is a positive indication
bishops score > 4
what is a contraindication for giving ergometrine during the third stage of labour
hypertension
