intrapartum care

Question 1

labour definition

Answer 1

reg painful contractions, progressive cervical change, descent

Question 2

fetal attitude components

Answer 2

fetal lie - longitudinal, transverse, oblique

presentation - vertex, face, brow, breech, shoulder/arm, compound, placenta or cord

position - OA = best, sacro-anterior for breech, mentum anterior for face

station

Question 3

movements of labour

Answer 3

engagement
descent
flexion
internal rotation
extension
restitution/external rotation
explusion

Question 4

initial assessment of labour

Answer 4

• vitals
• hx/antenatals - FM, bleeding, ctxns, ROM, preg/obhx, GBS, other hx
• palpate cntx
• FHR
• pain tolerance
• ROM?
• presentation
• VE
• test: group and screen if unknown
• admit if active or need observation, otherwise send home

Question 5

methods of fetal monitoring in labour

Answer 5

IA

• q15-30 min for 1 min after contraction
• q5min during pushing

if non-reassuring or high risk

• continuous FHR monitoring
• fetal scalp sampling if atypical/abnormal

Question 6

if power/contractions ineffective

Answer 6

ARM

oxytocin

Question 7

good contraction pattern

Answer 7

palpate mod-strong
45s
every 2-3min

can measure /w intra-uterine pressure catheter if assessment difficult or thick mec + decels

Question 8

correcting “passenger”

Answer 8

• position can rotate manually or forceps (dilated, at or below spines, bladder empty)
• maternal position: ROP can put in left lat to try to rotate

Question 9

modifying passage + pelvis types

Answer 9

• episiotomy
• mcroberts
• 4 types: gynecoid, android, anthroid, platypelloid

Question 10

sensory innervation

Answer 10

1st stage/uterus

• pain: t11-t12
• motor: t7-t8

2nd stage/perineum
- s2-s4, pudendal nerve

Question 11

anesthesia methods

Answer 11

General

• comfort measures
• narcotics: IM or IV, in 1st stage alone or adjunct, add anti-emetic, avoid <4 hrs before delivery
• NO + O2: multips in late 1st or 2nd stage, along or adjunct to local
• GA: emergency CS or if local CI/unavailable, risks of aspiration + HTN, abruption, coagulopathies, crosses placenta

local

• local: 1% lidocaine for repair or episiotomy
• pudendal block: 10ml lidocain each side, works in 5 min, for operative vag deliveries, transvag application through sacrospinous lig 1cm med and inf to ischial spine
• paracervical block: for D+C, can cause fetal bradycardia

regional

• epidural: anasthetic +/- narcotic, between ligamentum flavum and dura at L3-L4or5, 10-15min to effect, catheter, IV preload to avoid hypotension
• spinal: local anastetic smaller needle, easier, into subarachnoid space, risk of leak/headache + high block, used for elective C section /w narcotic for long acting