Brainscape's Knowledge GenomeTM

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


See full index

OnG > Labor > Flashcards

Labor Flashcards

1
Q

Indication of induction of labor

A

> Maternal

  • Postdate
  • PE, Eclampsia, PIH
  • GDM
  • Prolonged PROM
  • Indeterminate APH

> Fetus

  • Multiple pregnancy
  • Oligohydramnios
  • Reduced fetal movement
  • IUD
  • Chorioamnionitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Contraindication for induction of labor

A

> Maternal

  • Previous C-section
  • Previous myomectomy
  • Placenta praevia
  • Obstruction of birth canal
  • Active genital herpes
  • Invasive cervical cancer

> Fetus

  • Malpresentation: face/ brow
  • Abnormal lie: transverse/ oblique
  • Unstable lie at term
  • Breech presentation
  • Severe fetal compromised - IUGR
  • Cord prolapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prostin protocol in SGH

A

> Day 1

  • Maximum 2 prostin per day, 6 hours apart
  • If cervix remain unfavorable, rest for the night and come tomorrow

> Day 2

  • Insert 3rd prostin in the morning
  • If still unfavorable, discuss with specialist

> Day 3
- 4th prostin (if specialist decide)

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

Contraindication for Prostin

A
  • Allergy to prostaglandin
  • Prior C-section or other prior major uterine surgery (eg: myomectomy)
  • Asthma (PG cause bronchoconstriction)
  • Preexisting regular painful uterine activity - relative CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pros and Cons of Mechanical induction of labour

A

> Pros
- Effective, safe, cheaper and associated with low incidence of uterine hyper stimulation

> Cons

  • Bleeding
  • Device expulsion
  • Cervical laceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Contraindication for amniotomy

A
  • Maternal Hep B, HSV

- High presenting part (cord prolapse if not engaged)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complication of IOL

A

> Amniotomy

  • Cord prolapse
  • Injury to fetal part
  • Amniotic fluid embolism

> Prostin/ Oxytocin

  • Uterine hyperstimulation
  • Uterine rupture

> Others

  • Fetal distress
  • Chorioamnionitis
  • Failed induction -> EMLSCS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of uterine hyperstimulation

A

> CTG normal

  • Reduce the oxytocin infusion rate
  • Place in left lateral position
  • Continuous CTG monitoring
  • Close monitoring of contraction

> CTG non-reassuring

  • Stop oxytocin infusion
  • Consider tocolytic (eg: IV salbutamol 100ug or subQ terbutaline 250ug)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Induction vs Augmentation of labor

A

> Induction

  • Not in labor
  • Labor not start spontaneously
  • To initiate the onset of labor

> Augmentation

  • In labor
  • Labor start spontaneously
  • To speed up the process of labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Type of breech presentation

A
  • Extended (frank): Most common
  • Flexed (complete)
  • Footling: least common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Contraindication for ECV

A

> Maternal

  • Placenta previa
  • Recent APH
  • PROM
  • Multiple pregnancy
  • Preeclampsia
  • Uterine scar

> Fetus

  • Oligohydramnios
  • Polyhydramnios
  • Unstable lie
  • Abnormal CTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Step for ECV

A
  • Patient lie supine with 30” tilt either to left or right
  • Apply talcum powder/ gel over abdomen
  • With pelvic grip, breech is displaced to one iliac fossa
  • The other hand is placed over fetal head
  • Both hand works together to turn the fetus in FORWARD SUMMERSAULLT
  • Gentle, intermittent version force is applied over both pole
  • Max 3 attempts
  • Done at/ after 37 weeks
  • Failed -> repeat 1 week later/ ELSCS at 39 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Possible presenting diameter of fetal skull

A
  • 9.5cm: suboccipito-bregmatic (vertex, flexed)
  • 9.5cm: submento-bregmatic (face)
  • 11.0cm: oxxipito-frontal (vertex, military)
  • 13.5cm: vertico-mental (brow)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Contraindication of VBAC

A
  • Previous uterine rupture
  • Previous classical C-section
  • > = 2 previous C-section scar
  • Prior inverted T or J incision
  • Interval <18 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sign of impending uterine rupture

A
  • Abnormal CTG
  • Maternal pulse >100 bpm
  • Maternal BP <100/60
  • Persistent suprapubic pain
  • Hematuria
  • Increase PV bleeding
  • Loss of station of the presenting part
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

VBAC vs Repeat C-section

A

> VBAC

  • Able to move around earlier, shorter hospital stay
  • Higher risk of uterine scar rupture, additional risk of requiring transfusion
  • Higher risk of hypoxic-ischemic encephalopathy
  • Success rate reduce in: induction or augmentation of labor is required, BMI >30kg/m2, no previous vaginal birth, had previous C-section for shoulder dystocia

> Repeat C-section

  • Planned date of delivery
  • Higher risk of both placenta previa and accreta in subsequent pregnancy
  • Higher risk of respiratory morbidity
  • Required C-section in the future
17
Q

Cause of prolonged 2nd stage of labor

A
  • Passage: CPD, mass obstructing the passage
  • Passenger: macrosomic baby
  • Power: maternal exhaustion
18
Q

Retained placenta and its management

A
  • Definition: when the placenta is not delivered within 30 minutes of delivering the fetus
  • Monitor vital sign
  • Insert large bore IV access
  • Attempt CCT again
  • If still not delivered - Manual removal of placenta
19
Q

Indication and contraindication of tocolytic therapy

A

> Indication

  • To complete dexamethasone
  • For transport to tertiary centre

> Contraindication

  • IUGR
  • IUD
  • Severe APH
  • Chorioamnionitis
  • Maternal heart disease
20
Q

Example of tocolytic agents

A
  • Beta agonist: Terbutaline
  • Oxytocin antagonist: Atosiban
  • Calcium channel blocker: Nifedipine
21
Q

Pre-requisite for induction of labor

A
  • GSH 2 unit of blood
  • Absence of contraindication
  • Adequate counselling on indication, risk and option available
  • Reactive CTG
  • Presentation – cephalic
  • Level of presenting part – head must be engaged
  • Determine cervical favourability (Bishop’s score)
22
Q

Stages of labor

A

> 1st stage

  • Cervix dilated from 0-10cm
  • Latent phase (0-4cm): uterine contractions typically infrequent and irregular; slow cervical dilation and effacement
  • Active phase (4-10cm): rapid cervical dilatation to full dilatation; painful, regular contraction 2 min, lasting 45-60 seconds

> 2nd stage
- From full dilatation to delivery of the baby

> 3rd stage
- From full delivery of the baby to full delivery of placenta

23
Q

Management of prolonged 2nd stage of labor

A
  • Identify cause
  • If passage -> proceed to C-section
  • If passenger -> proceed to C-section
  • If power -> assisted vaginal delivery/ augmentation with oxytocin
24
Q

Pre-op preparation for LSCS

A
  • Take written consent
  • Catheterize, do vaginal examination
  • Ready GXM 2 units
  • Antibiotics: if membrane rupture >8 hours, operate after a failed vacuum or forceps delivery
  • Anaesthesia: spinal preferable
  • Preventing Mandelson syndrome: ranitidine 50mg (slow IV immediate before surgery)
25
Q

Post-operative care for LSCS

A
  • Allow orally
  • ¼ hourly vital signs monitoring
  • Adequate analgesia
  • Resume oral fluid after 12-24 hours
  • Contraception discussed
  • Sterilization during C-section after 3rd LSCS
26
Q

Neonatal complication of LSCS

A
  • Iatrogenic prematurity
  • Birth trauma (mild laceration, more common in emergency delivery)
  • Transient tachypnoea of newborn
27
Q

Degree of perineal tear

A
  • First degree: through skin and structure superficial to muscle
  • Second: through muscles of perineal body
  • Third: through the anal sphincter muscle
  • Fourth: anal sphincter muscle with a breach of the rectal mucosa
28
Q

Success rate of planned VBAC

A
  • 72-75% (Royal collage of OnG)
29
Q

Causes of breech presentation

A
  • Prematurity (most common)
  • Short cord
  • Poly/ Oligohydramnios
  • Uterine abnormalities (eg: fibroid, bicornuate, septate)
  • Placenta praevia
30
Q

Complication of preterm labor

A
  • Hypothermia
  • Respiratory distress syndrome
  • Patent ductus arteriosus
  • Intraventricular hemorrhage
  • Necrotizing enterocolitis
31
Q

Management of chorioamnionitis

A
  • Immediate delivery under antibiotic cover
  • Postpartum: 3 dose of IV antibiotics + oral antibiotic for >= 10 days
  • Ab of choice: IV cefuroxime and IV metronidazole

OnG (14 decks)

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