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Reproductive system > Intrapartum and post partum care > Flashcards

Intrapartum and post partum care Flashcards

1
Q

What is the natural rate of twinning?

A

1:90

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2
Q

What is the incidence of monozygotic twins?

A

4:1000

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3
Q

What increases the incidence of dizygotic twins?

A 
Age
Parity
Weight
Height
Higher in some families
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4
Q

When would multiple pregnancy be suspected?

A

Large for date uterine size
Multiple fetal heart rates are detected
Multiple fetal parts are felt
Human chorionic gonadotrophin and and maternal serum alphafetoprotein elevated for gestational age
Pregnancy with assisted reproduction technique

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5
Q

How is multiple pregnancy diagnosed?

A

Ultrasound

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6
Q

What causes monozygotic pregnancy?

A

Fertiliation of a single egg which splits into two

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7
Q

What causes dizygotic pregnancy?

A

Ovulation of 2 egg cells which are both fertilised

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8
Q

What are monochorionic twins?

A

When twins within the uterus are within the same chorion, and share a placenta

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9
Q

Within how many days of fertilisation does cleavage of the egg result in dichorionic/diamniotic twins?

A

3 days

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10
Q

What are monochorionic/monoamniotic twins?

A

Twins sharing the same chorion/placenta and are within the same amniotic sac - much higher fetal mortality rate

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11
Q

Within how many days of fertilisation does cleavage of the egg result in monochorionic/diamniotic twins?

A

4-8 days

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12
Q

Within how many days of fertilisation does cleavage of the egg result in monochorionic/monoamniotic twins?

A

9-12 days

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13
Q

What happens if the fertilised egg is cleaved after 12 days?

A

Conjoined twins

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14
Q

What are the different types of placentation of monozygotic twins?

A

Dichorionic/diamniotic
Monochorionic/diamniotic
Monochorionic/monoamniotic

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15
Q

What are complications of multiple pregnancy?

A 
High perinatal mortality and morbidity
Abortion
Nausea and vomiting
Preterm labour
Intrauterine growth restriction
Preeclamptic toxaemia
Polyhydramnios
Congenital anomalies
Postpartum haemorrhage
Placental abruption/placenta previa
Discordant twin growth
Cord prolapse
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16
Q

What are cause of perinatal mortality and morbidity?

A 
Prematurity- Respiratory distress syndrome
Birth trauma
Cerebral haemorrhage
Birth asphyxia
Congenital anomalies
Still birth
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17
Q

What is twin-twin transfusion?

A

Occurs in monochorionic twins - 20-25% incidence

One fetus donates blood to the other due to a vascular anastamosis

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18
Q

What happens as a result of twin-twin transfusion?

A

Recipient fetus will have heart failure, polyhydramnios, and hydrops
Donor fetus will have intrauterine growth restriction and oligohydramnios

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19
Q

How is twin-twin transfusion managed?

A

Amnio-reduction of recipient twin
Intra-uterine blood transfusion for donor twin
Selective fetal reduction
Fetoscopic laser ablation of placental anastamosis

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20
Q

What is hydrops?

A

Large amounts of fluid builds up in fetal tissues and organs causing extreme swelling

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21
Q

What is amnioreduction?

A

Removal of amniotic fluid - used for polyhydramnios

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22
Q

What is antenatal management in multiple pregnancy?

A

Adequate nutrition - 300 additional calories per fetus
Prevent anaemia
More frequent antenatal visits
USS checks
Multifetal reduction for high order multiple gestation in first trimester
Preterm labour risk - serial cervical length assessment, steroids for fetal lung maturation

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23
Q

What ultrasound checks are done in multiple pregnancy?

A

Chorionicity at 9-10 weeks
Nuchal translucency at 12-13 weeks
Assessment of fetal growth and wellbeing every 3-4 weeks from 23 weeks onward

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24
Q

How is labour managed in multiple pregnancy?

A

Depends on presentation, gestational age, presence of fetal complications, experience of obstetrician
Usually if first fetus is cephalic normal delivery
If not cephalic - cesarean
If locked twins - cesarean
Active management of third stage of labour to prevent post partum haemorrhage

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25
Q

What are locked twins?

A

One is cephalic

One is breech

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26
Q

What are the three main categories of pain relief in labour?

A

Drug free techniques
Simple drug therapies
Advanced drug therapies

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27
Q

What are non drug techniques for labour anagesia?

A 
Use of a birthing ball
Birthing pool
TENS machines
Hypnobirth
Aromatherapy
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28
Q

What is a TENS machine?

A

Transcutaneous electrical nerve stimulation

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29
Q

What are simple drug therapies for labour pain relief?

A

Entonox

Diamorphine

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30
Q

What are advanced drug therapies for pain relief in labour?

A

Remifentanil PCA

Epidural

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31
Q

What is another name for entonox?

A

Gas and air

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32
Q

How long does entonox take to work?

A

30 seconds

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33
Q

What are advantages of entonox?

A 
Widely used
Safe
Under the patient's control
Acts quickly
Wears off quickly
Can be used with other therapies
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34
Q

What are negative effects of entonox?

A 
Dizziness
Dry mouth
Nausea
Helps you cope but does not take all pain away
Take practice
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35
Q

How is diamorphine administered?

A

Injection at top of leg

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36
Q

What are benefits of diamorphine?

A

Works in 30 mins
Lasts 4 hours
Relaxes you
Helps to cope with labour

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37
Q

What are negative effects of diamorphine?

A

Nausea/vomiting
Drowsiness
Bradypnoea
Similar effects on baby - especially if received several times

38
Q

What is remifentanil PCA?

A

Remifentanil patient controlled analgesia pump

39
Q

How long does remifentanil take to reach full effect?

A

1 minute

40
Q

How long does a patient have to wait before receiving another dose of remifentanil?

A

2 minutes since last dose

41
Q

What are benefits of remifentanil PCA?

A

Patient is in control
Works quickly and wears off quickly
Strong pain relief

42
Q

How is labour defined?

A

The process through which the fetus, placenta, and membranes are expelled via the birth canal

43
Q

What is normal term for labour?

A

37-42 weeks

44
Q

What are key physiological changes that happen to allow initiation of labour naturally?

A

Cervix softens
Myometrial tone changes to allow for coordinated contractions
Progesterone decreases
Oxytocin and prostaglandins increase to allow labour to initiate

45
Q

What is stage I labour?

A

Process of dilatation of cervix - complete when cervix is fully dilated - lasts 8 hours on average

46
Q

What is the latent first stage of labour?

A

Period during which there are intermittent often irregular painful contractions - bring cervical effacement and dilatation up to 4 cm

47
Q

What is established first stage of labour?

A

Regular painful contractions that that result in progressive effacement and cervical dilatation from 4cm

48
Q

What rate is the cervix expected to dilate at?

A

0.5-1cm per hour

49
Q

What is stage II of labour?

A

From full cervical dilatation to the birth of the baby

50
Q

How long is stage II of labour expected to take in primagravida and multigravida patients?

A

Primagravida - 2 hours

Multigravida - 1 hour

51
Q

What is stage III of labour?

A

Time from the birth of the baby to the expulsion of the placenta and membranes

52
Q

What is active management of stage III of labour?

A

Routine use of uterotonic drugs
Deffered clamping and cutting of cord
Controlled cord traction after signs of seperation from placenta

53
Q

What is physiological management of the third stage of labour?

A

No routine use of uterotonic drugs
No clamping of cord until pulsation has stopped
Delivery of the placenta by maternal effort

54
Q

When should prolonged third stage of labour be diagnosed?

A

If stage III is not completed within:
30 minutes of birth with active management
60 minutes of birth with physiological management

55
Q

What must be monitored throughout labour?

A

Blood pressure, pulse, temp, resp rate, oxygen sats, urine output and urinalysis
Abdominal palpation - fetal lie, engagement
Vaginal examination - cervical effacement and dilatation
Monitoring of liquor once spontaneous or artifical rupture of membranes occurs (colour, smell, volume)
Auscultation of fetal heart
Palpation of uterine muscle contractions

56
Q

How is fetal heart auscultated?

A

Doppler

Cardiotocograph

57
Q

What is the target for frequency and length of uterine muscle contractions?

A

3-4 per 10 minutes

Lasting 40-60 seconds moderate to strong in strength

58
Q

How is fetal position determined?

A

Relation to the occiput

59
Q

What is the normal mechanism of labour? ie what steps does the fetus go through

A 
Descent
Flexion
Internal rotation of the head
Crowning and extension of the head
Restitution
Internal rotation of shoulders
External rotation of head
Lateral flexion
60
Q

What score is used to assess the cervix for induction of labour?

A

Bishop’s score

61
Q

What are the 5 components of Bishop’s score?

A 
Dilation (cm)
Length of cervix/effacement (cm)
Position
Consistency
Station (cm)
62
Q

How is dilation scored in Bishop’s score?

A 
0cm = 0
1-2cm = 1
3-4cm = 2
5+cm = 3
63
Q

How is effacement of the cervix scored in bishops score?

A 
3cm = 0
2cm = 1
1cm = 2
0cm = 3
64
Q

How is position scored in Bishop’s score?

A 
Posterior = 0
Mid = 1
Anterior = 2
65
Q

How is consistency scored in Bishop’s score?

A 
Firm = 0
Medium = 1
Soft = 2
66
Q

How is station scored in Bishop’s score?

A

-3cm = 0
-2cm = 1
-1, 0cm = 2
+1, +2cm = 3

67
Q

What are absolute contraindications to induction of labour?

A

Abnormal lie
Known pelvic obstruction such as tumour or large ovarian cyst
Placenta praevia
Fetal distress

68
Q

What are relative contraindications for induction of labour?

A

Previous cesarean

Asthma

69
Q

What is used to induce labour?

A

Prostaglandin analogues - per vagina

Oxytocin - IV

70
Q

What are examples of prostaglandin analogues?

A

Misoprostol

71
Q

What i augmentation of labour?

A

Increasing frequency, duration, and intensity of contractions in labour

72
Q

What is used to augment labour?

A

IV oxytocin

73
Q

When is augmentation of labour required?

A

When contractions reduce in frequency or strength in active labour

74
Q

What medications are used in active management of stage III labour?

A

Syntometrine

Oxytocin

75
Q

How is primary post partum haemorrhage defined?

A

> 500ml blood loss from the genital tract witihn 24 hours of delivery

76
Q

What medication is given for post partum haemorrhage?

A

Oxytocin
Syntometrine
Prostaglandins
Tranexamic acid

77
Q

Why are steroids used in preterm labour?

A

To improve neonatal outcomes

78
Q

What gestation will steroids be given at if there is risk of preterm?

A

24-35 weeks

79
Q

What are toclytic drugs?

A

Drugs which reduce contractions - used to try to delay labour

80
Q

What medications are used for hypertension in pregnancy?

A

Labetolol
Nifedipine
Methyldopa
Hydralazine

81
Q

What is the first line antihypertensive in labour?

A

Labetolol

82
Q

What medication is used in women with symptomatic preeclampsia or at risk of eclampsia?

A

IV magnesium sulphate

83
Q

What are components of breast milk?

A 
Water
Protein
Carbohydrates
Fats
Vitamins and mineral
Transfer factors
Anti-inflammatories
Hormones
Oligosaccharides
Enzymes
White cells
Viral fragments
Immunoglobulins
84
Q

What are features of colostrum?

A 
Packed with protective factors
Concentrated nutrition
Strong anti-inflammatory factors
Stimulates gut growth
Small volumes
Laxative effect to clear meconium
85
Q

What are babies at risk of without breastfeeding?

A 
Gastroenteritis
Resp infections
Allergies
Obesity
Type I and II diabetes
Sudden infant death syndrome
Necrotising enterocolitis
86
Q

How do babies develop a microbiome in their gut?

A

Exposure to maternal microbes in womb and in vagina during birth
Skin to skin contact
Breastfeeding
Breast milk oligosaccharides develop microbiome

87
Q

What are the 3 stages of lactogenesis?

A

Lactogenesis I - Breast development and colostrum production - 16 weeks gestation
Lactogenesis II - Onset of copious milk secretion - 32 -96 hours after birth
Lactogenesis III - maintenance of milk production

88
Q

What causes mothering behaviours?

A

Oestrogen and progesterone levels drop

Prolactin and oxytocin levels rise in response to touch, smell, and sight of baby

89
Q

What hormones are involved in breast milk?

A

Prolactin - production, responsive to touch and stimulation

Oxytocin - responsible for milk delivery - Acts on muscle cells in pulsatile action, levels higher when baby is near

90
Q

What are general benefits of oxytocin?

A

Lowers blood pressure and improves sleep
Reduce cortisol
Reduce pain sensitivity
Boost immune system

91
Q

What are benefits to skin contact between mother and baby?

A

Triggers lactation and mothering hormones
Regulates temperature, heart rate, and breathing in baby
Colonises baby with microbes
Stimulates feeding behaviour
Reduce stress hormones in mother and baby

Reproductive system (26 decks)

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