Intrapartum & Postpartum Care Flashcards
Breastfeeding reduces the mothers risk of which diseases?
1) Breast, Uterine and Ovarian cancers
2) Type 2 diabetes
3) Osteoporosis
What other health benefits does breastfeeding provide to the mother?
- Increased resilience to stress
- Improves quality of sleep
What is the NHS Grampian and WHO recommendation for breastfeeding?
Exclusive breastfeeding for the first 6 months to achieve optimal growth, development and health followed by nutritionally adequate complementary foods whilst breastfeeding continues for up to 2 years of age
What are the different phases of the 1st stage of labour and their associated cervical dilatation?
1 - Latent phase (0-3cms)
2 - Active phase (3-7cms)
3 - Transition (7-10cms)
What is the 2nd stage of labour?
- Full dilatation of the cervix to 10cm
- Pushing begins
- Baby moves from uterus into vagina
What is the 3rd stage of labour?
Delivery of the placenta
How far apart are contractions in the early stages of labour (0-4cm dilated)?
5-30 minutes
How far apart are contractions during active labour (3-7cms)?
2-5 minutes
How far apart are contractions during the transition/2nd phase of labour (8-10cm dilatation)?
1-3 minutes
What is shoulder dystocia and what are its associated dangers?
Shoulder dystocia - one of the childs shoulders becomes stuck behind the mothers pubic bone
Dangers of shoulder dystocia:
- Umbilical cord entrapment
- Inability of childs chest to expand properly
- Severe brain damage or death due to hypoxia
- Brachial plexus damage
How is shoulder dystocia managed?
HELPERR
H - Call for Help
E - Evaluate for Episiotomy
L - Legs (McRoberts position)
P - Suprapubic Pressure
E - Enter Manouvers (Internal rotation(
R - Remove the posterior arm
R - Roll the patient (onto all fours)
What are the causes of PPH?
Remember 4T’s
Thrombin (failure of clotting) - Pre-eclampsia, placental abruption, pyrexia in labour
Tissue - Retained placenta, placenta accreta, retained products of conception
Tone - Placenta praevia, over distension of uterus
Trauma - C-section, Episiotomy, Macrosomia
Other causes - Asian ethnicity, anaemia, induction, BMI > 35
What are the different types of PPH?
Primary - in 1st 24hours after delivery > 500ml blood (common 1/20 woman), severe haemorrhage = >2000ml
Secondary - >24 hours to up to 6 weeks post delivery
How is PPH managed?
1 - Call for help
2 - ABCDE
3 - Empty bladder
4 - Oxytocin, carboprost, misoprostol
OR
5 - Surgical
6 - Fluid replacement +- blood products
What is cord prolapse?
The descent of the umbilical cord through the cervix alongside or past the presenting part of the baby
What are monozygotic and dizygotic twins known as and how many eggs and sperms do they have?
Monozygotic (Identical) - 1 egg and 1 sperm
Dizygotic (non-identical) - 2 eggs and 2 sperm
What do the amnion and chorion layers of the embryo do?
Amnion - warmth and protection
Chorion - Nutrition
Which drugs can be used to induce labour?
1 - Prostaglanding analogues e.g. misoprostol (encourages cervical dilatation)
2 - Oxytocin (initiates contractions and increases frequency and force of contractions)
Which antihypertensive drugs are contraindicated in pregnant woman?
ACE Inhibitors
Angiotensin receptor blockers
Spironolactone
What are the analgesia options available to woman during labour?
Non-pharmacological - Breathing exercises, aromatherapy, warm baths
Simple Analgesia - Paracetamol, Dihydrocodeine, Aspirin
Analgesia:
1) Entonox (Nitrous Oxide & Oxygen) which can be self-administered during contractions by inhaling through mouthpiece
2) Opiates (morphine, diamorphine
Local anaesthesia:
1) Pudendal nerve block for forceps delivery
2) For suturing an episiotomy or vaginal tear
Epidural anaesthesia
Spinal anasthesia - used for most C-sections
