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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

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2
Q

what is the risk of a cord prolapse?

A
  • Risk of foetal hypoxia due to cord compression
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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

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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

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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

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6
Q

why is pushing cord back not recommended?

A
  • Pushing cord back is not recommended  need to keep warm and wet, want minimal
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7
Q

what is a shoulder dystocia?

A

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

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8
Q

what conditions are linked to shoulder dystocia?

A
  • Linked to macrosomia secondary to gestational diabetes
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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

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10
Q

what is restitution?

A

turning of head in delivery

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11
Q

what is a turtle neck sign?

A
  • Turtle neck sign – where head is delivered but retracts back, in vagina
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12
Q

what obstetric techniques can be used in shoulder dystocia?

A

episiotomy
McRoberts
Rubins manoeuvre
woods screw manoeuvre

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13
Q

what is an episiotomy?

A

enlarge the vaginal opening and reduce the risk of perineal tears

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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

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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

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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

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17
Q

what are complications of shoulder dystocia?

A
  • Fetal hypoxia (subsequent cerebral palsy)
  • Brachial plexus injusy and Erbs palsy
  • Perineal tears
  • PPH
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18
Q

how many births in the UK use instruments?

A

10%

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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

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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)

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21
Q

what risks can baby get from instrumental delivery?

A

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

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22
Q

what is ventouse?

A

suction cup on a cord

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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
what are forceps?
: like large metal salad tongs – come in two pieces of curved metal that attach together
26
how does forceps work?
- 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
what are complications of forceps delivery?
- 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
how would a femoral nerve injury present in mum?
- Femoral nerve  weakness of knee extension, loss od patella reflex and numbness of anterior thigh and medial lower leg
29
how would obturator nerve injury present?
- Obturator nerve  hip adduction and rotation, numbness of medial thigh
30
when would a perineal tear occur?
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
what are RF for perineal tears?
RF: first birth, large babies (over 4kg), shoulder dystocia, Asian ethnicity occipito-posterior position, instrumental deliveries
32
how do you classify perineal tears?
- 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
how do you manage perineal tears?
first degree does not require sutures  second require stitching but can be done bedside - Third/ 4th needs theatre
34
post tear, what conservative management can be given?
- 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
do women who have tears require CS on subsequent preg?
not all women that are symptomatic after third/ 4th degree tears are offered an elective C.section for subsequent pregnancies
36
what complications can arise from a perineal tear?
- Pain - Infection - Bleeding - Wound breakdown - Lasting complications: urinary incontinence, anal incontinence/ altered bowel habit, sexual dysfunction and dyspareunia, psychological and MH consequences
37
what is a PPH?
Postpartum haemorrhage: bleeding after delivery of baby and placenta - Biggest potential cause of maternal death
38
what is classed as a PPH?
- Loss of 500ml after vaginal delivery - Loss of 1000ml following CS Minor: <1000ml major > 1000ml
39
what is a primary PPH?
- Primary PPH: bleeding within 24hrs of birth
40
what is a secondary PPH?
- Secondary pph: from 24hrs to 12weeks from birth
41
what can cause a PPH?
Causes: four Ts - Tone: uterine atony – most common cause - Trauma – perineal tear - Tissue – retained placenta - Thrombin – bleeding disorders
42
what are RF for PPH?
- 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
what preventative measures can be done to prevent a PPH?
- 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
what is emergency procedure in PPH?
: 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
what mechanical treatment can be done in PPH?
rubbing uterus (stimulates contractions) or catherisation
46
what medications can be used in PPH?
oxytocin erogemtrine carbopost misoprostol tranexamic acid
47
why is ergometrine IV/IM given in PPH?
- Ergometrine: IV or IM stimulating smooth muscle contraction
48
why is carbopost given IM in PPH?
- Carbopost: IM – prostaglandin analogue that stimulates uterine contraction
49
how is oxytocin for PPH given?
 given as 40 units in 500ml
50
why is tranexamic acid given in PPH?
- Tranexamic acid: antifibrinolytic
51
what surgical methods are given in PPH?
- Intrauterine balloon tamponade b-lynch suture uterine artery ligation hysterectomy
52
53
what is intrauterine balloon tamponade?
inflatable balloon to press against bleeding
53
what is B-lynch suture?
sutures around uterus to compress it
54
what is uterine artery ligation?
reduce blood flow
55
what would most likely cause secondary PPH?
Secondary PPH: likely due to retained products of conception or infection
56

Obs&Gynae (17 decks)

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