Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

cOGtext > Labour > Flashcards

Labour Flashcards

1
Q

Define Labour.

A

Products of conception expelled from uterus >24 weeks gestation.

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

Before how many weeks gestation is labour considered pre-term?

A

Before 37 weeks

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

What is the average length of labour for primiparous and parous women?

A

primiparous - 10 hours (unlikely to exceed 18 hours)

parous - 5.5 hours (unlikely to exceed 12 hours)

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

Describe the 1st stage of labour.

A

Onset of regular contractions
Cervical changes
Lasts until full dilatation of cervix and no longer palpable

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

The 1st stage of labour is split into the early latent phase and the active phase. Describe the cervical changes that occur in each.

A

Early latent phase - cervix becomes effaced, shortens in length and dilates to 4cm

Active phase - cervix fully dilates to 10cm

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

Describe the 2nd stage of labour.

A

From full cervical dilatation to delivery of foetus

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

The 2nd stage of labour is split into passive and active stages. Describe each.

A

Passive - full dilatation of cervix prior to or in absence of involuntary expulsive contractions

Active - baby is visible/ persistent involuntary expulsive contractions/ other signs of full cervical dilatation/ active maternal effort in absence of involuntary expulsive contractions

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

When is prolonged 2nd stage abour diagnosed in nulliparious women?

A

At 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is prolonged 2nd stage labour diagnosed in multiparious women?

A

At 1 hour

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

What is the first-line management of prolonged labour?

A

Refer to obstetric reg unless birth is imminent

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

List 4 complications of prolonged labour.

A

Foetal distress
PPH
Pelvic floor dysfunction
Fistulae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the 3rd stage of labour.

A

Time between delivery of foetus and delivery of placenta and membranes
Occurs 10-15 mins post foetal delivery and can last up to 30 mins

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

Describe physiological management of the 3rd stage of labour.

A

No drugs, cord not clamped until pulsations ceased

Placenta delivered by maternal effort

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

Describe active management of the 3rd stage of labour.

A

Use of uterotonic drugs (oxytocin or syntometrine) with delivery of anterior shoulder or immediately after birth or before cord stops pulsating
Bladder catheterisation
Deferred cord clamping and cutting
Controlled cord traction after sings of placental separation

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

Outline the signs of placental separation from membranes.

A

The uterus contracts, hardens and rises
Umbilical cord lengthens permanently
There’s a gush of blood variable in amount
Placenta and membranes appears at introitus.

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

Outline the pros and cons of active management of the 3rd stage of labour.

A

Pro - shortens length of 3rd stage

cons - increase risk of N&V, haemorrhage and blood transfusion

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

When is a change from physiological management of 3rd stage labour to active management indicated?

A

Excessive bleeding of haemorrhage occurs
Failure to deliver the placenta within one hour
The patient’s desire to shorten the third stage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe 3 clinical signs of the onset of labour.

A

Regular, painful contractions that increase in duration and frequency
Passage of blood stained mucous from cervix
Rupture of membranes

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

What is the definition of prelabour rupture of membranes?

A

If the period between rupture of membranes to painful contractions is >4hours.
Called premature rupture of membranes if occurs before full-term gestation.

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

Describe hormonal changes that occur to initiate labour.

A

progesterone decreases
oestrogen and oxytocin increase thus increasing prostaglandin production
CRH is also thought to be involved - increases oestrogen and prostaglandin synthesis and reduces progesterone

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

How does oxytocin act to initiate labour?

A

released from posterior pituitary
acts on decidual tissue to promote prostagladin release
Initiates and sustains contractions
Also synthesised directly in decidual and extraembryonic tissue and placental tissue
oxytocin receptors in myometrial and decidual tissues increases towards end of pregnancy to increase uterine contractility

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

State another 2 hormones that influence uterine myocytes.

A

relaxin
activin A

(influence cAMP production causing relaxation of myometrial cells. Relaxin also helps soften pelvic ligaments and the pubic symphysis so allow room for baby to exit)

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

Describe 3 changes in the cervix towards term gestation/in labour.

A

Decreased collagen
Increased hyaluronic acid (softens and stretches the cervix by decreasing affinity for fibronectin and collagen and increasing affinity for water)
Progressive uterine contractions causes effacement and dilatation of cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

State the 7 stages of labour.

A 
Engagement
Descent 
Flexion 
Internal rotation 
Extension 
External rotation (restitution)
Expulsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How is engagement assessed in the 1st stage of labour.
Assessing how much of the foetal head can be felt in the abdomen, this is done in 5ths. i.e. if all of the head can be felt in the abdomen - it is 5/5 parts palpable. If no head can be felt it is 0/5 parts palpable.
26
List 8 possible causes of abnormal labour.
Malpresentation (non-vertex) Malposition (occipitoposterior, occipitotrasnverse) Preterm labour <37 weeks Post-term labour >42 weeks Too painful - requires anaesthestic input Too quick (<2 hours) - hyperstimulation, precipitate labour Too long - failure to progress Foetal distress (hypoxia, sepsis)
27
Use the 3 Ps of labour to suggest reasons for failure to progress.
Powers - inadequate contractions Passage - trauma, shape, cephalopelvic disproportion Passenger - big baby, malposition
28
What are the possible complications of obstructed labour?
Sepsis - ascending genitourinary tract infection PPH fistula formation Foetal asphyxia Neonatal sepsis Uterine rupture - increased risk if previous scar Obstructed AKI
29
How is progression of labour assessed?
Vaginal examination every 4 hours to assess cervical dilatation, descent of presenting part and signs of obstruction (moulding, caput, anuria, haematuria, vulval oedema)
30
How is failure to progress defined?
<2cm cervical dilatation in 4 hours
31
State the 3 types of forceps that can be used for operative vaginal delivery and give an example of each.
Outlet forceps - Wrigley's Mid-cavity/ low-cavity forceps - Neville barnes, Andersons, Simpsons Rotational forceps - Kielland's forceps (should be performed with appropriate anaesthesia in theatre)
32
What is required for a forceps delivery? HINT - use the pneumonic FORCEPS
Fully dilated cervix (10cm) Occipitoanterior position (possible with Keilland forcepts and ventouse) Ruptured membranes Cephalic presentation Engaged presenting part Pain relief Sphincter (bladder) empty - may require catheterisation
33
Give some indications for operative vaginal delivery.
Failure to progress in 2nd stage Foetal distress Maternal exhaustion Special indication (i.e. if 2nd stage needs to shortened) include maternal cardiac disease, severe pre-eclampsia/ eclampsia, intra-partum haemorrhage, umbilical cord prolapse
34
List some disadvantages to operative vaginal delivery.
``` neonatal trauma; marks on babies face brachial plexus injury Facial nerve palsy Shoulder dystocia ``` ``` Perineal trauma incl. 3rd and 4th degree tears Psychological trauma Bowel symptoms Urinary symptoms PPH ```
35
List some disadvantages to c-section.
``` Haemorrhage Infection VTE Visceral injury (bladder and ureters) Longer hospital stay Risk of uterine rupture in future labours x4 greater risk of maternal mortality Transient tachypnoea of the newborn ```
36
What are the advantages and disadvantages to ventouse delivery vs forceps?
less perineal trauma more likely to fail can cause cephalohaematoma and retinal haemorrhage
37
What are the contraindications to ventouse?
``` Prematurity (<34 weeks) Face presentation Suspected foetal bleeding disorder Foetal predisposition to fracture e.g. osteogenesis imperfecta Maternal HIV or hep C ```
38
Give 4 indications for the induction of labour.
``` >42 weeks gestation Pre-eclampsia Placental insufficiency and IUGR Antepartum haemorrhage Rhesus isoimmunisation Diabetes mellitus Chronic renal disease ```
39
What is used to assess the outcome of induction of labour?
Bishop's score using cervical examination
40
What 5 measurements does Bishop's score use?
``` Cervical dilatation (cm) Effacement (%) Station Cervical consistency Cervix position ``` score of 6 = labour likely after induction score <5 = cervical ripening required
41
What determines the method of induction?
Whether membranes are ruptured | Bishop's score
42
List the 5 methods of induction and give a caution for each.
Stripping of membranes/ sweep (involves finger inserted into cervix) - NNT high Amniotomy to rupture membranes - requires soft cervix and engagement of head - risk of cord prolapse and placenta praevia Synthetic oxytocin infusion (following amniotomy) - can cause uterine hyperstimulation leading to foetal asphyxia, may also cause uterine rupture Cervical ripening and prostaglandin E2 (pessaries or gel applied to posterior fornix, or oral) - contraindicated if uterine scar due to risk of hyperstimluation or rupture Mechanical cervical ripening - balloon catheter into cervix for 12 hours then removed to allow amniotomy
43
What measurements are involved in a partogram?
``` Foetal heart rate Cervical dilation Duration of labour Colour of liquor Frequency and duration of contractions Caput and moulding Station or descent of the head Maternal heart rate, BP and temperature ```
44
What is the common side effect of entonox gas?
nausea
45
What are the contraindications to regional anaesthesia during labour?
``` maternal refusal coagulopathy local or systemic infection uncorrected hypovolaemia inadequate staff experience or facilities ```
46
What are the 3 methods of regional anaesthesia during labour?
Epidural Spinal Pudendal nerve block
47
Give 3 advantages to epidural analgesia.
Complete pain relief in most women Doesn't increase risk of c-section Can be controlled by patient Can be topped up to allow operative deliveries
48
Give 3 disadvantages to epidural analgesia.
Lack of pressure sensation may reduce desire to push during active second stage Reduced uterine contraction due to loss of Ferguson reflex Increased risk of assisted vaginal delivery Causes abnormal foetal heart rate Hypotension Accidental dural puncture Postural headache dependent on gauge of cannula High block may cause maternal respiratory depression Atonic bladder
49
What does an epidural consist of?
Local anaesthetic agent (e.g. bupivacaine) injected into a fine catheter in the epidural space between L3-4 Addition of an opioid reduces dose requirement of bupivacaine and spares motor fibres to lower limbs and reduces complications i.e. hypotension and abnormal foetal heart rate
50
What is mechanism of action of a pudendal nerve block?
local anaesthesia injected around the pudendal nerve at the level of the ischial spine often used for operative vaginal delivery
51
What are the disadvantages of pudendal nerve block?
can be ineffective risk of haemorrhage from pudendal artery risk of lignocaine toxicity if inadvertent muscular injection
52
How is spinal anaesthesia used?
catheter inserted into subarachnoid space between L3-4 and anaesthetic agent injected commonly used for operative delivery
53
Why is spinal anaesthesia not used for pain control in labour?
because of the superior safety of an epidural and its ability to top up with suitable doses or use as a continuous infusion
54
Give some examples of narcotic analgesia that can be used in labour.
pethidine morphine remifentanil
55
What are the disadvatages to narcotic analgesia?
nausea and vomiting | foetal respiratory depression
56
What is the mechanism of action of remifentanil?
ultra-short acting opioid that offers superior pain relief to pethidine with less desirable SE on foetus
57
Give 3 maternal indications for CTG monitoring during labour.
Gestation <37 weeks or >42 weeks Induced labour Administration of oxytocin Ante/intrapartum haemorrhage Maternal illness (e.g. diabetes, cardiac or renal disease, hyperthyroidism, maternal infection) Pre-eclampsia Previous uterine scar (c-section or myomectomy) Contractions > 5 in 10 or lasting more than 90 seconds During/ following insertion of epidural block. Maternal request
58
Give 3 foetal indications for CTG monitoring during labour.
Abnormal doppler artery velocimetry Known or suspected IUGR Oligohydramnios or polyhydramnios Malpresentation Meconium stained liquor Multiple pregnancy (all babies need to be monitored) Suspected small for gestational age or macrosomia Reduced foetal movements in the last 24hours reported by the woman Two vessel cord Prolonged rupture of membranes >24hours unless delivery is imminent A rise in baseline, repeated decelerations or slow to recover decelerations or overshoots. Foetal structural abnormalities diagnosed during the antenatal period and planned for CEFM.
59
What may meconium indicate?
foetal distress/ hypoxia/ obstructed labour prolonged pregnancy in a term infant breech presentation may be normal
60
What is the disadvantage to CTG monitoring during labour?
non-specific and increase medical intervention
61
Describe how to interpret a CTG. | Hint - Dr BrVADO
``` Define risks e.g. pre-eclampsia, diabetes Baseline foetal heart rate Variation in foetal HR Accelerations (>15bpm above baseline) Decelerations (>15bpm below baseline) Overall impression ```
62
What CTG changes are non-reassuring/abnormal?
``` Foetal bradycardia (HR<100) Foetal tachycardia (HR>160) Sinusoidal HR pattern <5 accelerations in 90 mins Late decelerations Reduced variability ```
63
What should be done if a CTG is non-reassuring?
``` inform senior move to left lateral position encourage fluids (IV or oral) Stop oxytocin Consider tocolysis ```
64
What should be done if you suspect an abnormal or pathological CTG?
inform senior start conservative measures offer foetal blood sampling exclude factors that indicate need for immediate delivery (cord prolapse, uterine rupture, hyperstimulation, abruption) Treat dehydration, hyperstimulation, hypotension and change position
65
What should be done if you suspect an abnormal or pathological CTG that requires urgent intervention?
Inform senior start conservative measures makes preparations for urgent birth (category 1 c-section)
66
When is foetal blood sampling indicated and how is it performed?
when their are abnormalities in foetal HR during labour and foetal acidosis is suspected an amnioscope is used to obtain blood from the foetal scalp, cervix must be >3cm dilated
67
What is normal foetal pH?
7.25-7.35
68
What is the management plan if foetal blood pH is <7.2 and high lactate?
deliver - forceps or c-section
69
What are the 4Hs and 4Ts that can cause collapse that also need to be considered in pregnancy?
Hypovolaemia Hypoxia Hypo/hyperkalaemia Hypothermia Thromboembolism Toxicity Tension pneumothorax Tamponade (cardiac)
70
What are the causes of maternal collapse isolated to pregnancy?
pre-eclampsia/ eclampsia | intracranial haemorrhage
71
What are the possible causes of maternal hypovolaemia in pregnancy?
bleeding relative hypovolaemia of dense spinal block septic or neurogenic shock
72
What are the possible causes of maternal hypoxia in pregnancy?
peripartum cardiomyopathy myocardial infarction aortic dissection large vessel aneurysms
73
What are the possible causes for thromboembolism in pregnancy?
amniotic fluid embolism pulmonary embolus air embolus myocardial infarction
74
How does an amniotic fluid embolism present?
``` acute respiratory distress and cardiovascular collapse in a patient during labour or in one who has recently delivered acute hypotension respiratory distress acute hypoxia seizures and cardiac arrest may occur ```
75
What are the complications of amniotic fluid embolism if the woman survives?
left ventricular dysfunction or failure | disseminated intravascular coagulation resulting in massive PPH

cOGtext (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions