Extras Flashcards
How do you measure the foetal heart rate in intermittent auscultation?
Pinard stethoscope
hand held Doppler
Name three methods of continuous foetal monitoring?
CTG
scalp ECG
abdo ECG
What does ‘Dr C Bravado’ stand for in a CTG?
Dr - define risk
C - contractions
Bra - baseline rate
V - variability
A - acceleration
D - deceleration
O - overall
… normal … non-reassuring …. pathological
What is a normal baseline foetal heart rate on a CTG?
110-160bpm
What is normal amount of variability in foetal heart rate?
> 5bpm
When is there sometimes less variability in foetal heart rate?
when they’re asleep!
but this shouldnt last more than 90mins
Should acceleration be present on CTG?
yes
Should deceleration be present on CTG?
early decels are normal
varibale decels are non-reassuring
late decels are pathological
What do you worry about if there’s late decels on CTG?
placental insufficiency
Which is more invasive but more effectives - scalp ECG or abdo ECG?
scalp ECG more invasive but more effective - don’t have to go through layers of abdo
What else does CTG show except from foetal heart rate?
uterine contractions
When does the first stage of labour end?
when cervix is fully effaced and dilated
When does second stage of labour end?
with birth of babby!
When does third stage of labour end?
with delivery of placenta
What are three parts of the first stage of labour?
- latent
- active
- transition
A woman is having irregular contractions, lasting around 30 seconds each, with mucoid show. She is 2cm dilated. What stage in she in?
first stage - latent (0-3cm)
A woman is having regular contractions, lasting 1 min each, 5cm dilated. What stage is she in?
first stage - active (3-7cm)
A woman is having INTENSE contractions, lasting 2 mins and running into each other. She is screaming “I’m gonna die”. Her waters have broken and she is 9cm dilated. What stage is she in?
first stage - transition (7-10cm)
Which stage of labour is the pushing stage, when the head comes through the pelvis?
second stage
Which foetal lie is ideal?
longitudinal
What is foetal station?
presenting part in relation to ischial spines. (a.k.a degree of descent)
What is foetal engagement?
head in pelvis (5/5 engaged = head fully in)
When should you “now pant, Maureen. Pant”
crowning (so don’t tear)
What position should baby be in when coming out?
face down (occipito-anterior)
What is waters breaking?
amniotic sac rupturing
Describe what happens in the third stage of labour.
uterus contracts
placenta separates from wall
placenta delivered
When is the window of implantation?
day 20-24
In what situation does Rhesus disease happen?
Rhesus neg sensitized mum attacks Rhesus pos baby
In rhesus disease, rhesus neg sensitized mum attacks Rhesus pos baby. What does this cause for the foetus?
haemolysis - anaemia
Who do you give anti-D prophylaxis to?
all rhesus negative pregnant women
Name non pharma management of labour pain
hydrotherapy
massage
TENS (transcutaneous electrical nerve stimulation)
Analgesia in labour can be systemic or regional. Name two systemic and two regional.
systemic:
IM pethidine
Entonox
regional:
epidural
spinal
where does spinal cord end?
L1/2
Where do you go in for epidural?
L3/4 (btw iliac crests)
What are two problems with epidural?
best pain relief but may prolong labour and raise mother’s temp.
How is spinal different to epidural?
go THROUGH dura into CSF to make completely numb fast (intra-thecal)
When do you use spinal anaesthetic?
only for defined period e.g. before elective Caesarean (cant leave cath in, dont want CSF infection)
With general anaesthetic - what is one danger to mother and one danger to baby?
mother - aspiration gastric contents
baby - risk of anaesthetising baby
Give me some examples of when sensitization culd happen (foetal and mum’s blood mixing)?
abdo trauma
APH
amniocentesis / invasive procedures
When is booking appointment?
8-12wks
When is dating scan? What else happens at dating scan as well as dating?
12 wks
screening for trisomy 13 (patau’s), 18, 21.
When is first trimester?
conception - 12wks
When is second trimester?
13wks - 27wks
When is third trimester?
28wks - 41wks
How long does each trimester roughly last?
3 months
When is the anomaly scan?
20wks
Midwifery check, birth planning and education appointment. When is this?
34wks
