Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obs&Gynae > L+D > Flashcards

L+D Flashcards

1
Q

what is a cord prolapse?

A

Cord Prolapse: umbilical cord descends below the presenting part of fetus and through cervix into vagina after rupture of foetal membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the risk of a cord prolapse?

A
  • Risk of foetal hypoxia due to cord compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how does a cord prolapse arise?

A

RF: fetus is an abnormal lie after 37 gestation
- In cephalic lie  head typically descends the pelvis without room fro cord to descend

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how do you diagnose a cord prolapse?

A

Diagnosis: umbilical cord prolapse should be suspected there are signs of fetal distress on CTG
- Speculum can be used to confirm diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do you manage cord prolapse?

A

emergency c.section
- Pushing cord back is not recommended  need to keep warm and wet, want minimal
- Woman can lie in left lateral position (pillow under hip)
- Tocolytic medication (eg tebutaline) can minimise contractions whilst waiting for delivery by c.section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why is pushing cord back not recommended?

A
  • Pushing cord back is not recommended  need to keep warm and wet, want minimal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a shoulder dystocia?

A

when anterior shoulder of baby becomes stuck behind pubic symphasis of pelvis after head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what conditions are linked to shoulder dystocia?

A
  • Linked to macrosomia secondary to gestational diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how would shoulder dystocia present?

A

Presentation: difficulty in face and head and obstruction in delivering of shoulders
- Failure of restitution
- Head remains face downwards (occipito-anterior) and does not turn sideways as expected after delivery of head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is restitution?

A

turning of head in delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a turtle neck sign?

A
  • Turtle neck sign – where head is delivered but retracts back, in vagina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what obstetric techniques can be used in shoulder dystocia?

A

episiotomy
McRoberts
Rubins manoeuvre
woods screw manoeuvre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is an episiotomy?

A

enlarge the vaginal opening and reduce the risk of perineal tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is McRoberts in obstetrics?

A

McRoberts: involves hyperflexion of mother at hip (bringing her knees to abdo)  posterior pelviv tilt, lifting pubic symphysis up and out of way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is rubins manoeuvre?

A

involves reaching into vagina to put pressure on posterior aspect of babys anterior shoulder to help move under pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is wood screw manoeuvre?

A

during rubins  reach in vagina and push pressure on anterior aspect of posterior shoulder
- Top shoulder is pushed forwards and bottom shoulder is pushed back and rotate baby and helping delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are complications of shoulder dystocia?

A
  • Fetal hypoxia (subsequent cerebral palsy)
  • Brachial plexus injusy and Erbs palsy
  • Perineal tears
  • PPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how many births in the UK use instruments?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what would indicate the need for instrumental delivery?

A

Indication: based on clinical judgement of midwife/ obstetric
- Failure to progress
- Foetal distress
- Maternal exhaustion
- Control of heads in various foetal position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

instrumental delivery puts mum at extra risks, what are they?

A

: having instrumental delivery increases risk to mother:
- PPH
- Episiotomy
- Perineal tears
- Injury to anal sphincter
- Incontinence of bladder/ bowel
- Nerve injury (obturator or femoral nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what risks can baby get from instrumental delivery?

A

subgaleal haemorrhage (most dangerous), intracranial haemorrhgae, skull haemorrhage, spinal cord injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is ventouse?

A

suction cup on a cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how does ventouse cup work?

A
  • Suction goes on babys head, the dr and midwife applies careful traction to the cord to help pull baby out of the vagina
24
Q

what are main complications of ventouse cup?

A
  • Main complication: cephalohematoma: collection of blood between skull and periosteum
25
Q

what are forceps?

A

: like large metal salad tongs – come in two pieces of curved metal that attach together

26
Q

how does forceps work?

A
  • Go either side of baby head and grip head in a way that allows dr or midwife to apply careful traction and pull head from vagina
27
Q

what are complications of forceps delivery?

A
  • Main complication: facial nerve palsy with facial paralysis
  • Can leave bruises on baby’s face  can develop fat necrosis leading hardened lumps of fat on cheeks
  • Fat necrosis can resolve overtime by itself
28
Q

how would a femoral nerve injury present in mum?

A
  • Femoral nerve  weakness of knee extension, loss od patella reflex and numbness of anterior thigh and medial lower leg
29
Q

how would obturator nerve injury present?

A
  • Obturator nerve  hip adduction and rotation, numbness of medial thigh
30
Q

when would a perineal tear occur?

A

Perineal tears: occurs when external vaginal opening I s too narrow to accommodate the baby  skin and tissue in area tearing as baby head passes

31
Q

what are RF for perineal tears?

A

RF: first birth, large babies (over 4kg), shoulder dystocia, Asian ethnicity occipito-posterior position, instrumental deliveries

32
Q

how do you classify perineal tears?

A
  • First- degree: injury limited to frenulum of labia minora
  • Second-degree: includes perineal muscles but affecting the anal sphincter
  • Third degree: includes anal sphincter but not affecting rectal mucosa
  • Fourth-degree: rectal mucosa
33
Q

how do you manage perineal tears?

A

first degree does not require sutures  second require stitching but can be done bedside
- Third/ 4th needs theatre

34
Q

post tear, what conservative management can be given?

A
  • Broad-spec antibiotics
  • Laxaties: to reduce risk of constipation and wound dehiscence
  • Physio: reduce risk and severity of incontinence
  • Follow up: monitoring for longstanding complications
35
Q

do women who have tears require CS on subsequent preg?

A

not all
women that are symptomatic after third/ 4th degree tears are offered an elective C.section for subsequent pregnancies

36
Q

what complications can arise from a perineal tear?

A
  • Pain
  • Infection
  • Bleeding
  • Wound breakdown
  • Lasting complications: urinary incontinence, anal incontinence/ altered bowel habit, sexual dysfunction and dyspareunia, psychological and MH consequences
37
Q

what is a PPH?

A

Postpartum haemorrhage: bleeding after delivery of baby and placenta
- Biggest potential cause of maternal death

38
Q

what is classed as a PPH?

A
  • Loss of 500ml after vaginal delivery
  • Loss of 1000ml following CS
    Minor: <1000ml major > 1000ml
39
Q

what is a primary PPH?

A
  • Primary PPH: bleeding within 24hrs of birth
40
Q

what is a secondary PPH?

A
  • Secondary pph: from 24hrs to 12weeks from birth
41
Q

what can cause a PPH?

A

Causes: four Ts
- Tone: uterine atony – most common cause
- Trauma – perineal tear
- Tissue – retained placenta
- Thrombin – bleeding disorders

42
Q

what are RF for PPH?

A
  • Previous PPH
  • Multiple pregnancy
  • Obesity
  • Large baby
  • Failure to progress in second stage of labour
  • Prolonged third stage
  • Pre-eclampsia
  • Retained accreta ( placenta grows too deeply into uterine wall  placenta remains attached)
  • Retained placenta – placenta does not come fully out
  • Instrumental delivery
  • GA
  • Episiotomy or perineal tear
43
Q

what preventative measures can be done to prevent a PPH?

A
  • Treating anaemia during antenatal period
  • Giving birth with empty bladder  full bladder can reduce uterine contractions
  • Active management of third stage eg IM oxytocin
  • IV tranexamic acid during Csections in higher risk
44
Q

what is emergency procedure in PPH?

A

: EMERGENCY
- Resus with A-E
- Lie woman flat, keep warm and communicate with her and partner
- Insert two large bore cannulas
- Bloods: FBC, U+E, clotting
- Group and cross match – 4 units
- Warmed IV fluids and blood resus as required
- Oxygen  regardless of sats
- FFP: if clotting abnormalities or after 4 units of major blood transfusion
- Activate major haemorrhage protocol

45
Q

what mechanical treatment can be done in PPH?

A

rubbing uterus (stimulates contractions) or catherisation

46
Q

what medications can be used in PPH?

A

oxytocin
erogemtrine
carbopost
misoprostol
tranexamic acid

47
Q

why is ergometrine IV/IM given in PPH?

A
  • Ergometrine: IV or IM stimulating smooth muscle contraction
48
Q

why is carbopost given IM in PPH?

A
  • Carbopost: IM – prostaglandin analogue that stimulates uterine contraction
49
Q

how is oxytocin for PPH given?

A

 given as 40 units in 500ml

50
Q

why is tranexamic acid given in PPH?

A
  • Tranexamic acid: antifibrinolytic
51
Q

what surgical methods are given in PPH?

A
  • Intrauterine balloon tamponade
    b-lynch suture
    uterine artery ligation
    hysterectomy
52
Q
A
53
Q

what is intrauterine balloon tamponade?

A

inflatable balloon to press against bleeding

53
Q

what is B-lynch suture?

A

sutures around uterus to compress it

54
Q

what is uterine artery ligation?

A

reduce blood flow

55
Q

what would most likely cause secondary PPH?

A

Secondary PPH: likely due to retained products of conception or infection

56
Q
A

Obs&Gynae (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions