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MBBS VI: O&G > Labor > Flashcards

Labor Flashcards

1
Q

Definition of:
- Labor
- Term
- Preterm labor
- Miscarriage
- Prolonged labor

A
  • labor: products of gestation expelled from uterine cavity after 24w
  • term: labor at 37-41+6 weeks
  • preterm labor: labor at 24-37w
  • miscarriage: labor before 24w resulting in non-viable fetus
  • prolonged labor: labor lasting ≥24h in primigravida and ≥16h in multigravidas
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2
Q

When is there risk of CPD (Cephalopelvic Disproportion)?

A

fetus has relatively large head → tight fit → risk of CPD

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3
Q

What may affect bloodflow to the uterus?

A
  • Uterine contractions
  • Further decrease in bloodflow to the uterus by decreased venous return due to IVC compression and increased intrathoracic pressure during pushing
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4
Q

3Ps of labor: main determinants of labor

A
  • passage: birth canal (bony pelvis, soft tissue, cervix)
  • passenger: fetus (size, presentation, position)
  • power: uterine contractions, maternal effort
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5
Q

1st stage of labor

A

Onset of labor to cervix fully dilated (as upper uterus contract)
* latent phase: tubular cervix to 3cm dilatation + fully effaced
* active phase: 3cm cervix to 7cm dilatation
* transition: 7cm cervix to 10cm (fully dilated)

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6
Q

2nd stage of labor

A

Cervix fully dilated to delivery of fetus
* passive (pelvic) phase: cervix fully dilated to onset of urge to push (uterine contraction only, no urge to push)
* active phase: maternal urge to bear down until fetus delivered
* prolonged 2nd stage = >2h in nulliparous; 1h in multi → instrumental delivery

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7
Q

3rd stage of labor

A

Delivery of fetus till delivery of placenta

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8
Q

4th stage of labor

A

1-2h after delivery of placenta when uterus contract to stop bleeding from placenta

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9
Q

What is onset of labor? What are the different types of contractions?

A

Definition: regular, usu painful, contractions that bring about progressive cervical changes

  • Braxton-Hicks (warm up) contractions (無痛宮縮): irregular contractions in last 1m of pregnancy, help build strength for contractions of labor
  • False labor: irregular contraction, w/o cervical changes, not change when lie down
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10
Q

Signs of labor

A
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11
Q

What are the mechanisms initiating labor?

A
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12
Q

What is the process of contraction and retraction?

A
  • Contractions (tightening)
  • Retraction (shortening)
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13
Q

Monitoring of contractions

A
  • non-invasive: external tocography, palpation → record frequency and duration only
  • invasive: intrauterine catheter transducer → can record intrauterine pressure but of little clinical use (no outcome benefit)
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14
Q

What are the common dimensions of the AP diameter and transverse diameter of the pelvic inlet? What is the true conjugate and obstetric conjugate?

A
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15
Q

What is the AP diameter of the pelvic outlet?

A

AP diameter (13.5cm) >
transverse diameter (11cm), i.e. a sagittal strait

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16
Q

What are the types of pelvis?

A
17
Q

What is the terminology with regards to fetal position?

A
  • Lie: relationship between long axes of fetus and uterus (longitudinal, oblique, transverse)
  • Presentation: cephalic (head = majority), breech, shoulder (transverse lie)
  • Attitude: degree of flexion of fetal upper C spine. Well flexed –> vertex presentation (most ideal) i.e. suboccipital bregmatic. Less well flexed –> occipitofrontal. Extende –> brow presentation i.e. occipitomental (13cm) –> vaginal delivery is contraindicated. Hyperextended –> face presentation i.e. submentobregmetic
  • Position (relationship of denominator to inlet of maternal pelvis. Vertex = occiput, face =chin (mento), breech = sarcum (sarco), shoulder = acromion. Position (position of denominator with repsect to mother): left occipito anterior (LOA) = occipital is pointing towards left anterior side of the mothers vagina. Determined by PV exam by palpating orientation of suture and fontanelles
  • Station and engagement: engagement (when greatest traverse diameter (biparietal) has pased through inlet of true pelvis (<2/5 head palpable above brim). station: how many 5ths of head palpable.
  • Descent (station): position of presenting part with regards to ischial spine (-1 = 1cm above spine, +1=1cm below spine)
18
Q

Which babies are delayed cord clamping done in?
What is the advantage?

A

At least 30-60 seconds but is not appropriate when mother or newborn are unstable or when newborn placental circulation is not intact (previa/abruption)
* >30s in preterm biths
* >1 min in term births

Adv
* Higher iron stores at 6 months of age which is beneficial when mother has a low ferritin lvel or plans to breastfeed without iron supplementation
* Decreases neonatal and infant anemia
* Decreases IVH
* Facilitate fetal to neonatal transition

19
Q

What are the disadv of delayed cord clamping?

A
  • Polycythemia in growth restricted neonates
  • Hyperbilirubinemia resulting in more phototherapy
  • Less umbilical cord for harvesting stem cells
20
Q

How to define active phase of 1st stage of labor?
When does 1st stage need active Mx?

A

Active phase: 3cm cervix to 7cm dilatation (10cm = fully dilated)

After 3cm onwards (active phase of 1st stage), should normally dilate 1-2cm/h. Here, the cervix only dilates 1cm after 4h –> poor 1st stage progress. Artificial rupture of membrane should be done given adequate fetal descent (-2 or lower).
Syntocinin given if fetal descent is not adequate

21
Q

What is Mx for CTG showing decreased variability and recurrent late decelerations?

A

Fetal scalp blood (only if not imminent delivery)

22
Q

In breech presentation, when can you not do ECV?

A
  • Placenta previa or abruptio placentae
  • Non reassuring fetal status
  • IUGR in association with abnormal umbilical artery doppler index
  • Isoimmmunization
  • Severe preeclampsia
  • Recent vaginal bleeding
  • Significant fetal or uterine anomalies

Other contraindications
* Rupture of membrane
* Fetus with hyperextended head
* Multiple gestations (however ECV may be considered for a second twin after delivery of the first

23
Q

What are the indications for classic Caesarean section?

A
24
Q

How to manage grade 3 placenta previa that is posteriorly located?

A

C/S

MBBS VI: O&G (109 decks)

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