Intrapartum Care Flashcards
What are Braxton Hicks Contractions?
Mild, irregular contractions from 30+ weeks gestation
What are the 3 stages of Labour
1st stage - dilation and effacement - 10cm cervix
2nd stage - full dilation –> delivery of the baby
3rd stage - delivery of baby –> delivery of placenta and membranes
Describe contractions in the second stage of labour
Should be occurring every 2-5 mins
Lasting 60-90 seconds
Difference between active and expectant management of the third stage of labour
Active - immediate IM syntocinon, cord clamping + traction, <30 mins
Expectant - uterine massage, delayed cord clamping, <60 mins
Describe the APGAR scoring system
Appearance Pulse Grimace Activity Respiration
Each scored from 0-2 points
Healthy baby should be 10/10
Describe how to interpret a CTG
Dr - determine risk
C - contractions - regular, strong, 4-5/10 mins
Br - Baseline rate - 100-160 bpm
A - Accelerations - >15bpm/15 seconds
Va - Variability - >5+ bpm
D - Decelerations - >15bpm/15 seconds
O - overall impression - worrying, reassuring etc
Ranges for Fetal Blood Sample monitoring
> 7.25 = normal
7-2 - 7.25 = borderline
<7.2 = delivery indicated - due to acidosis
Drug profile of Entonox
50:50 ratio of NO : O2
Quick onset, effective pain relief
S/E - dry mouth, N+V, light headedness
S/E profile of opioids used in labour
Pethidine/Diamorphine
Crosses placental barrier - can lead to neonatal respiratory depression if used <2hrs from delivery
+ves and -ves of Epidural anaesthetic
+ves:
- can be topped up
- can be used to control BP (drops it)
- ves:
- hypotension
- patchy blockade
- respiratory depression
+ves and -ves of Spinal anaesthetic
+ves:
- dense, reliable blockade
- easier and quicker to administer
- ves
- may cause severe hypotension
- can’t be topped up
- drops venous return - use left lateral tilt to maintain adequate venous pressure
What does Bishops score of the cervix signify?
Factors in: - dilation, effacement, station, consistency, position
Indicates likelihood of a successful induction
<5 = unlikely >6/>9 = likely/very likely to succeed
Stepwise progression RE induction of labour:
1) Stretch and sweep - release local prostaglandins
2) Prostaglandins (PO/Topical) - check CTG before/after
3) Syntocinon infusion - dose titrated to achieve desired contractions
4) ARM - commitment made to delivering fetus
Risk of uterine scar rupture in induced labour?
Normal labour - 5:1000
Syntocinon - 8:1000
Prostaglandins - 24:1000
What is uterine hyperstimulation and how is it managed?
Contractions lasting >2mins, or >5:10 frequency
Can –> uterine rupture/abruption/fetal distress
Managed with terbutaline
