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Intrapartum Care: Normal Labour Flashcards

1
Q

What 2 drugs can be used to induce labour

A

Prostaglandins

Oxytocin

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2
Q

What should be checked 30m before and after giving prostaglandins

A

CTG

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3
Q

After how long can a second dose of prostaglandins be given

A

6h

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4
Q

Can oxytocin be started with prostaglandins and why

A

No. Wait 6h - otherwise causes hyperstimulation

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5
Q

Explain giving oxytocin to induce labour

A

Oxytocin should be started at lowest dose and gradually increases to given 3-4 contractions in 10 minutes.

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6
Q

What should a patient be on if oxytocin

A

Continuous CTG monitoring

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7
Q

What should be checked if oxytocin is used for more than 12h and why

A

U+E. Oxytocin has ADH features and hence can cause dilutional hyponatraemia

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8
Q

Define failure to progress

A

<2cm dilation in 4h first stage labour

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9
Q

What is dysfunctional labour

A

Individual has poor labour from offset

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10
Q

Define secondary arrest

A

individual has initial good progress which then ceases

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11
Q

Define labour

A

regular, increasing and efficient uterine contractions

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12
Q

What proceeds labour

A

show

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13
Q

What is a show

A

cervical mucus as membranes rip from the OS

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14
Q

How is labour divided

A

First stage
Second stage
Third stage

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15
Q

How long does the first stage take in a primip

A

8-18h

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16
Q

How long does the first stage take in a multip

A

5-12h

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17
Q

What does the first stage of labour involve

A

Dilation of cervix from 0-10cm

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18
Q

How can the first-stage of labour be divided

A
  1. Latent phase

2. Established phase

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19
Q

What are 2 features of latent phase of labour

A
  • Irregular contractions

- Cervix dilates to 4cm

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20
Q

What is the established phase of labour

A
  • Cervix dilates 4-10cm
  • Effacement
  • Regular contractions
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21
Q

What rate does cervix dilate in established phase

A

<0.5cm/hour

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22
Q

What are 3 clinical features of stage I labour

A

Bloody Show
Cervical dilation
SROM

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23
Q

What is second stage labour

A

From cervical dilation (10cm) to delivery

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24
Q

How long is second stage in nulliparous

A

3h

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25
Q

If delivery is not imminent in nulliparous women in what time frame should an obstetrician be called

A

2h

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26
Q

How long is second stage in multiparous and when should obstetrician be called

A

2h. Call if not imminent in 1h

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27
Q

How can second stage be divided

A

Passive

Active

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28
Q

What is passive stage of labour

A

Cervix dilated to 10cm
Mother has no urge to push
Baby remains high in pelvic

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29
Q

What may increase duration passive stage of labour

A

Epidural

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30
Q

How long may epidural increase passive stage by

A

1-2h

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31
Q

What is the active phase of labour

A

Maternal urge to push

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32
Q

What is a mnemonic to remember stages of labour (1+2)

A

LEPA

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33
Q

What are the sub categories of stage 1 and 2 labour

A

Latent phase
Established phase
Passive stage
Active stage

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34
Q

What is stage 3 labour

A

From delivery of foetus to delivery of placenta

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35
Q

How long does stage 3 labour usually take

A

1h

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36
Q

What happens to the uterus post-delivery

A

returns to pre-24w size

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37
Q

If the uterus does not return to normal size what may it indicate

A

choriocarcinoma

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38
Q

Explain separation of placenta

A

Contraction uterus impedes venous return causing congestion of blood;

Retroplacental clot causes placenta to seperate

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39
Q

What are alvarez waves

A

low intensity, high-frequency contractions that occur after 20W

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40
Q

What are braxton hicks contractions

A

high intensity contractions that happen after 20W - usually lasting 1-minute

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41
Q

In what time frame may false labour occur

A

3-4W pre-term

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42
Q

What is false labour

A

Irregular contractions of moderate intensity - not increasing in frequency or intensity. No cervical changes

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43
Q

What is used to manage false labour

A

Analgesia

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44
Q

What time frame does pre-labour occur

A

3-4d before term

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45
Q

What is pre-labour

A

irregular contractions of high-intensity occurring every 5-10m

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46
Q

What is the role of pre-labour

A

position head

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47
Q

What is the rate of contractions in labour

A

3-4 in 10 minutes

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48
Q

What is measured every 15m during first stage labour

A

Foetal HR, unless on CTG

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49
Q

What is check every 30m in first stage labour

A

Contractions: strength and frequency

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50
Q

What is the ideal rate of contractions

A

3-4 in 10m

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51
Q

What is checked every 60m in first stage labour

A

Maternal HR

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52
Q

What is checked every 4h in labour first stage

A

Maternal BP and T

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53
Q

What is checked every 1h in second-stage labour

A

Maternal pulse and BP

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54
Q

What is checked every 4h in second-stage labour

A

Maternal Temp

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55
Q

What is checked every 30m in second-stage labour

A

Contractions

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56
Q

Why may pressure be applied over perineum in second stage

A

To prevent precipitated delivery= childbirth after rapid labour, which leads to expulsion of the infant and risk intracranial haemorrhage

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57
Q

How long is cord clamping delayed

A

1m

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58
Q

If a premature baby how long is cord clamping delayed

A

3m

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59
Q

What are the signs of third stage

A

Uterus contracts

Cord lengthening

60
Q

What is used to manage third stage labour

A

Syntometrine

61
Q

What is syntometrine

A

Ergometrine and oxytocin

62
Q

Why is syntrometrine given

A

Reduces third stage to 5m

Reduces risk PPH

63
Q

What is problem with syntometrine

A

can precipitate MIs

64
Q

When is syntrometrine CI

A

pre-eclampsia, severe HTN

65
Q

If BP has not been measured during pregnancy what is give as alternative to synto

66
Q

What should be used to monitor parameters of labour in all women

67
Q

What are the two lines on a partogram

A

Action and alert lines

68
Q

What is normal labour

A

Labour is to the left of action and alert lines

69
Q

What is the alert line

A

line drawn at 1cm/h from admission cervical dilation

70
Q

What is the action line

A

line 2-3cm to right of alert line

71
Q

What are 3 non-pharmacological methods of analgesia during labour

A
  1. Education about labour
  2. TENs
  3. Water birth
72
Q

When is water birth not possible

A

If high-risk birth on CTG monitoring

73
Q

What are 3 pharmacological methods to reduce pain during labour

A
  1. Narcotics
  2. Entonox
  3. Local anaesthetic
74
Q

What is entonox

A

Nitric oxide in oxygen

75
Q

What are 3 side effects of entonox

A

Lightheadedness
Nausea
Vomiting

76
Q

When is entonox contraindicated

A

Pneumothorax

77
Q

What narcotic can be used during labour

78
Q

What are the risks of pethidine to mother

A

Drowsiness

79
Q

What are risks of pethidine to baby

A

Respiratory depression

80
Q

What is the problem with birth plans and narcotics

A

Unable to enter birthing pool for 2h

81
Q

What form of patient controlled analgesia can be used in labour

A

Remifentanil

82
Q

When is local anaesthetic used

A

Used for episiotomy or suturing tears

83
Q

What is a pudendal nerve block

A

S2-S4 nerve block

84
Q

When is pudendal nerve block used

A

Perineal infiltration for Instrumental delivery

85
Q

What nerve roots does an epidural block

86
Q

What is the advantage of epidural

A

Cannula remains in epidural space so can be regularly topped up every 2h

87
Q

Why is epidural useful in pre-eclampsia

A

Causes maternal hypotension

88
Q

What needs to be checked before giving an epidural

A

Platelets.

Need to be >75

89
Q

What space is an epidural inserted

90
Q

What monitoring should happen in epidural

A

Maternal BP

91
Q

What may happen to foetus after inserting epidural and why

A

Bradycardia - due to maternal hypotension

92
Q

How long after LMWH can an epidural be put in

93
Q

How long should you wait following an epidural to administer LMWH

94
Q

What is spinal anaesthesia used for

95
Q

Define engagement

A

When the largest part of the babies head passes through pelvic inlet

96
Q

What is crowning

A

When babies head appears at the vagina

97
Q

How does the babies head enter the pelvis

A

Occipito-lateral

98
Q

What position is the babies head when it delivers

A

Occipito-anterior

99
Q

What is checked each vaginal exam during labour

A

Descent and engagement

100
Q

How is descent measured

A

By 5ths across pelvic brim

101
Q

What is 5/5

A

Whole head at pelvic inlet

102
Q

What is 4/5

A

Small part past pelvic brim - can be lifted into pelvis with a deep grip

103
Q

What is 3/5

A

Head cannot be lifted out of the pelvis

104
Q

What is 2/5

A

Majority head below pelvic brim

105
Q

What is 1/5

A

Only tip of the head is below the pelvic brim

106
Q

What does CTG measure

A

Aims to determine foetal distress by measuring acceleration/decceleration and pressure in the uterus

107
Q

What is the mnemonic to remember NICE indications for continuous CTG monitoring

108
Q

What are the indications for continuous CTG monitoring

A 
T > 38 
HTN: 160/110
Oxytocin 
Meconium severe 
Bleeding PV
109
Q

What is the normal foetal HR

110
Q

Define foetal tachycardia

A

HR >110 for >10 minutes

111
Q

What is mild foetal tachycardia

112
Q

What is severe foetal tachycardia

113
Q

What are 7 causes of foetal tachycardia

A
  • Stress
  • Maternal Fever
  • Chorioamnionitis
  • Medications
  • Hypoxia
  • Hypotension
114
Q

What is mild foetal bradycardia

A

HR <120 for >3 minutes

115
Q

What is severe foetal bradycardia

A

HR < 100 for >3 minutes

116
Q

What can cause foetal bradycardia

A

Heart defects
Supine hypotensive syndrome
CNS anomalies
Hypoxia

117
Q

What is acceleration

A

Temporary increase in HR by >15bpm for less than 10-minutes

118
Q

What causes acceleration

A

Baby moving

119
Q

What does absence of accelerations indicate

A

Sedatives
Sleeping
Hypoxic

120
Q

What is an early deceleration

A

Decrease in foetal HR of >15bpm for <3m

121
Q

Describe appearance of early deccelerations

A

The beginning and end of the deceleration coincides with uterine contraction. Reaches peak when uterine contraction reaches its maximum

122
Q

What is the nadir

A

Peak of deceleration

123
Q

What is the onset to nadir in early contractions

124
Q

What causes early decelerations

A

Uterus contraction causes head compression which increases vagal tone

125
Q

What is a late deceleration

A

Decrease in FHR that does not coincide with uterine contraction

126
Q

Explain nadir in late deceleration

127
Q

What causes late decelerations

A

Umbilical cord insufficiency cause foetal hypoxia and acidosis

128
Q

How are late decelerations usually managed

A

Urgent C-Section

129
Q

What are variable decelerations

A

Abrupt onset to nadir, leasts at least 15s

130
Q

What causes variable decelerations

A

Umbilical cord compression

Umbilical cord prolapse

131
Q

What is a prolonged deceleration

A

Decrease in FHR of more than 15bpm for 2-10m

132
Q

What do prolonged decelerations indicate

A

Foetal hypoxia

133
Q

What can prolonged decelerations lead to

A

Hypoxic-Ischaemic encephalopathy

Cerebral palsy

134
Q

What causes prolonged decelerations

A

Uterine contraction
IVC syndrome
Epidurals
Rapid drop in maternal BP

135
Q

What defines a short episode of decreased variability

A

Decrease in variability for less than 30-minutes

136
Q

What is the most common cause for short-episodes of decreased variability

A

Foetus sleeping

137
Q

When does decreased variability become concerning

A

More than 40 minutes

138
Q

What is a mnemonic to remember presentation and cause of CTG traces

139
Q

What does VEAL CHOP stand for

A

Variable decelerations
= Cord compression

Early decelerations
= Head compression

Accelerations
= Ok

Late decelerations
= Placental insufficiency

140
Q

What is a sinusoidal pattern on CTG

A
  • Smooth wave-like appearance.
  • Cycles every 2-5 minutes.
  • Baseline HR at 120-160
  • No beat to beat variability
141
Q

What does sinusoidal pattern on CTG mean

A

Maternal haemorrhage
Foetal anaemia
Foetal hypoxia

142
Q

If a foetus has suspected hypoxia what is next-line investigation

A

Foetal scalp blood sampling

143
Q

What determines whether a baby is delivered on foetal scalp blood sample

144
Q

If pH is less than 7.2 what should be done

A

Immediate delivery

145
Q

If pH is 7.21-7.24 what should be done

A

Repeat in 30m

146
Q

If pH is more than 7.25 what should be done

A

Repeat in 1h

Obstetrics (27 decks)

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