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Reproductive System > Intrapartum + Postpartum Care > Flashcards

Intrapartum + Postpartum Care Flashcards

1
Q

Steps of induction of labor and the medications used.

A
  1. ripening of uterus
    • prostaglandins - topical misoprostal
    • balloons (becoming preferred because less likely to cause fetal distress)
  2. amniotomy (if not spontaneous)
  3. augmentation (contractions) - IV oxytocin
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2
Q

5 things for ripening of uterus (same as Bishop’s score)

A
  1. effacement
  2. dilation (2-3 cm proceed to amniotomy)
  3. cervical position moves from posterior –> anterior
  4. softer
  5. fetal station near pelvis
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3
Q

which bishop’s score indicates that:

  1. induction is a success and spontaenous labor will occur
  2. labor unlikely to start without induction
  3. start amniotomy
A
  1. > 8
  2. <5
  3. > 7
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4
Q

indications for induction (8)

A

(in no particular order)

  1. DM
  2. prolonged pregnancy - 41 weeks max
  3. PROM
  4. maternal conditions: hypertension, on anticoagulants
  5. multiple pregnancies
  6. previous stillbirth, intrauterine death
  7. fetal conditions: growth restrictions, macrosomia, oligohydraminos
  8. mother’s request
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5
Q

contraindications for induction (7)

A
  1. placental previa/vasa previa
  2. anatomical abnormalities
  3. malpresentation
  4. cord prolapse
  5. fetal distress
    (relative risk)
  6. maternal asthma
  7. previous C section
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6
Q

when is pregnancy:

  1. how long is 1 pregnancy
  2. full term
  3. premature
A
  1. 40 wks
  2. 37 wks
  3. <37 wks
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7
Q

prolonged pregnancy poses risk for:

A

stillbirth

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8
Q

complications of induction of labor (6)

A
  1. uterine hypertonicity –> fetal distress
  2. fetal distress
  3. ruptured uterus - if prolonged or hypertonic
  4. adverse drug reaction (hypotension, hyponatremia)
  5. failed induction –> C section
  6. PPH
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9
Q

what are the 3 P’s that cause failure of labor to progress?

A
  1. power
  2. passages
  3. passenger
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10
Q

what is the suboptimal cervical dilatation in cm in the first stage of labor?

A

< 0.5 cm in primigravid
< 1 cm in parous
if > 4 cm and regular contractions –> labour should progress

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11
Q

what is the main natural inducer of cervical dilatation, and how is this related to adequate contractions?

A

contraction –> fetal head descends –> exert force on cervix –> dilatation

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12
Q

caput and moulding and how these happen

A

CPD (cephalopelvic disproportion, or when the fetal head is too big for the pelvis)

  1. caput - diffuse swelling of the scalp caused by pressure against cervix
  2. moulding - skull bones overlap
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13
Q

fetal presentation and fetal position

A

presentation:
- vertex/breech
- longitudinal/transverse
ideal - longitudinal lie, vertex presentation
position:
- right/left
- occipito-anterior/posterior
- occipito transverse
ideal - occipito anterior

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14
Q

how to identify the location of the occiput before delivery?

A

vaginal examination - feel fontanelles

  • anterior = diamond shaped
  • posterior = triangular shaped
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15
Q

causes of fetal distress (5)

A
  1. hypoxia
  2. infections
  3. placental previa/vasa previa
  4. cord prolapse
  5. placental abruption
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16
Q

why is oxytocin always given with fluid?

A

it causes hypotension and hyponatremia

17
Q

methods of fetal monitoring and when to use which

A
  1. intermittent auscultation (with doppler ultrasound, every 15 mins in 1st stage of labor and every 5 mins in 2nd stage) - low risk
  2. CTG (cardiotocography) - high risk or if abnormal intermittent auscultation
  3. fetal blood sampling - only if abnormal CTG
  4. fetal ECG
18
Q

what does CTG detect?

A
  1. fetal heart rate
  2. contraction rate
    - can also detect CNS, ANS changes due to hypoxia
19
Q

what does fetal blood sampling detect, and how was sample collected

A

scratch made to baby’s scalp with speculum and collected

  • detects pH of blood:
    • < 7.20: deliver immediately
    • 7.21-7.24: repeat in 30 mins if CTG stable
    • > 7.25: repeat in 1 hr if CTG stable
20
Q

how to read CTG (DR C BRVADO)

A

DR - determine risk, what is the need for CTG
C - contractions (4-5/10 mins)
BR - baseline rate (100-160 systolic)
V - variability
A - acceleration
D - deceleration, might be feature of normal labor, but prolonged or late deceleration indicates fetal distress
O - overall

21
Q

indications of C section

A
  • fetal distress
  • multiple pregnancy with malpresentation
  • failed induction/progress of labor
  • prolonged pregnancy
  • malpresentation
  • placenta previa/vasa previa
  • severe pre-eclampsia
  • previous C section
22
Q

type of incision done in C section

A

99% lower uterine segment incision (LUSI) - horizontal

23
Q

what does puerperinum mean

A

postnatal period, 6 weeks after delivery

24
Q

when where and for what reason would postnatal woman have her check up?

A

9-10 days: see midwife at home - check wounds, bleeding, endometritis, breast, debrief of events around birth, mental health
6 weeks: GP - contraception, mental health

25
Q

how fast can a postnatal woman get pregnant again?

A

21 days after delivery

26
Q

exact definition of postpartum haemorrhage (PPH) - primary & secondary

A
  1. primary: >500mL of blood loss within first 24 hrs

2. secondary: >500 mL blood after 24 hrs - 6 weeks

27
Q

what are the 4 T’s that cause primary PPH

A
  1. Tone: too little uterine contraction –> profuse bleeding
  2. Tear: vascular ares will bleed
    - 3rd degree: involves anal sphincter
    - 4th degree: involves rectal mucosa
  3. Tissue: retained pregnancy tissue, like placenta
  4. Thrombin: coagulation issues
28
Q

define lochia

A

normal bleeding after delivery, lasts 3-4 wks and is like normal period - no clots, not heavy

29
Q

when is a woman most at risk of thromboembolic disease?

A

6-10x increased risk of DVT/PE during pregnancy and 6 weeks postpartum. especially risky if immobilized after C section or spinal anesthetic

30
Q

what are some signs of thromboembolic disease in pregnancy?

A
  • unilateral leg swelling/pain
  • SOB/chest pain
  • unexplained tachycardia
31
Q

What are some investigations for Thromboembolic diseases, and what is a common test that is no longer reliable in pregnancy?

A

D-dimer not reliable.

  • ECG
  • leg doppler
  • CXR +/- VQ scan (avoid radiation if possible)
32
Q

treatment for DVT/PE

A
  1. low molecular weight heparin

2. warfarin (is TERATOGENIC, but OK during breast feeding)

33
Q

what is the main causative organism in postnatal woman and what is the management?

A

group A strep - strep throat

  1. IV abx within 1 hr
  2. IV fluids
  3. referral
34
Q

what are the 3 PN mental health issues and which of these require treatment? rank them in severity

A
  1. baby blues: due to hormonal changes 1-3 days PN, no treatment needed
  2. postnatal depression: increased risk in those with FH and in future pregnancies, classic signs of depression, functional impact and needs treatment
  3. puerperal psychosis: rare and severe disorder, danger to both mother and baby, inpatient care needed
35
Q

when does most eclamptic seizures happen?

A

most eclampsia happen PN Pre-eclampsia can start PN and worsen several days PN.

Reproductive System (7 decks)

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