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Y5 O&G > Labour > Flashcards

Labour Flashcards

1
Q

Define Labour.

A

Painful uterine contractions leading to effacement and dilation of the cervix

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2
Q

What percentage of births are natural, instrumental and C-section?

A
  • Natural = 60%
  • Instrumental = 10%
  • C-section = 30%
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3
Q

Define Braxton-Hicks contractions.

A

Painless contractions with no cervical change

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4
Q

What are the stages of labour?

A
  • 1st stage = painful uterine contractions up to full (10cm) cervical dilatation
    • Latent phase = painful, irregular contractions; dilation up to 4cm
    • Established stage 1 = regular painful contractions; ≥4cm dilation
  • 2nd stage = urge to push until delivery of the foetus
    • In nulliparous women = 3 hours (epidural) or 2 hours (no epidural)
    • In multiparous women = 2 hours (epidural) and 1 hour (no epidural)
  • 3rd stage = delivery of placenta and foetal membranes
    • Normally 5-10 mins but up to 30 mins
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5
Q

What is the widest point of the pelvic inlet and outlet?

A
  • Pelvic inlet = Transverse
  • Pelvic outlet = Anterior-posterior
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6
Q

What determines the progress of labour?

A
  • 3 P’s
    • Power - contractions
    • Passage - dimensions of pelvis
    • Passenger - diameter of foetal head
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7
Q

Define Restitution.

A

Brining head in line with the shoulders

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8
Q

Define Shoulder Dystocia.

A

When a baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body.

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9
Q

What are the risk factors for shoulder dystocia?

A
  • Macrosomia
  • High maternal BMI
  • DM or GDM
  • Prolonged labour
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10
Q

What are the signs and symptoms of shoulder dystocia?

A
  • Difficult face/chin delivery
  • ‘Turtling’ head (retracting)
  • Failure of restitution
  • Failure of shoulder descent
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11
Q

What is the management of shoulder dystocia?

A

1) Call for senior help + discourage pushing
2) McRobert’s manoeuvre (legs up to abdomen) and suprapubic pressure – 90% success
3) Evaluate for episiotomy
4) Either:

  • Rubin’s manoeuvre (push anterior shoulder towards baby’s chest)
  • Woods’ Screw (Rubin’s + push posterior shoulder towards baby’s back à rotation)
  • Deliver posterior arm (then, rotate 180 and deliver the other arm)

5) Change position to all fours and repeat the above manoeuvres
6) Symphysiotomy, cleidotomy (divide clavicles) or Zavanelli (reversal of normal delivery movements)
* Should all take <5 minutes

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12
Q

What scoring system is used to assess how likely a women is to go into labour soon?

A

Bishop’s score

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13
Q

Define Effacement/Thinning.

A

Percentage from 0% (normal length cervix) to 100% or complete (paper thin cervix).

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14
Q

Define Foetal station.

A

Position of the baby’s head relative to the ischial spines of the maternal pelvis.

  • If the head is level with the spines, the score is 0; however, above or below them can modify the score
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15
Q

Describe the Bishop’s score.

A
  • <3 = IOL unlikely to be successful
  • 3-5 = IOL with PV prostaglandin gel (should start labour or ripen cervix)
  • 6-8 = ARM (amniotomy ± oxytocin infusion if labour does not begin)
  • ≥9 = labour likely to occur spontaneously
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16
Q

If induction of labour doesn’t occur, what should be offered to try and induce labour?

A

Offer x2 PGE2 and then ARM

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17
Q

What is the management of the 1st stage of labour?

A
  • One-to-one midwifery care
    • Vaginal examinations performed 4-hourly or as clinically indicated
  • Progress of labour is monitored using a partogram with timely intervention if abnormal
  • Ensure adequate:
    • Analgesia ± antacids
    • Hydration and light diet to prevent ketosis (which can impair uterine contractility
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18
Q

What is the normal rate of progress in Latent 1st phase?

A
  • 1 cm every hour (a well flexed head will speed this up)
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19
Q

What is delayed rate of progress in Latent 1st phase?

A

<1cm over 2 hours

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20
Q

Describe Latent 1st phase.

A
  • Is generally silent as the cervix gradually effaces over a period of days/weeks
  • Intervention should be avoided where possible
  • Standing upright may encourage progress of labour - mobility is encouraged
  • Mobilise and managed away from the labour suite
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21
Q

Why is delayed 1st stage defined at a conservative rate of <1cm per 2 hours?

A

Is conservative to unsure intervention isn’t started too early

22
Q

What are the management for delayed 1st phase?

A
  • Membranes intact = ARM (Artificial Rupture of the Membranes) → review in 2 hours
  • Membranes ruptured = oxytocin:
    • Increase every 15-30 mins until regular contractions
    • Once regular contractions, review in 4 hours
23
Q

What are the types of delay in labour?

A
  • Primary dysfunctional labour → <2cm dilation in 2 hours, never progressed properly
  • Secondary arrest of labour → progressed well and then stopped
  • Prolonged latent phase → prolonged latent
  • Cervical dystocia → rare; cervix doesn’t dilate properly
24
Q

What is the management of the normal 2nd stage of labour?

A
  • Women discouraged from lying supine or semi-supine
  • Use of regional anaesthesia (epidural or spinal)
  • Encouragement
25
Q

What is the normal rate of progress in 2nd phase?

A
  • Nulliparous women = 3 hours (epidural) or 2 hours (no epidural)
  • Multiparous women = 2 hours (epidural) and 1 hour (no epidural)
26
Q

What is the normal rate of progress in Latent 1st phase?

A
  • 1 cm every hour (a well flexed head will speed this up)
27
Q

What is the first sign of 2nd phase of labour?

A

Urge to push with 10cm dilation

  • Regional anaesthesia may interfere with the normal urge to push
    • 2nd stage is more often diagnosed on routine scheduled vaginal examination
28
Q

What is the management of delivery?

A
  • Watch the perineum - between contractions, elastic tone of the perineal muscles will push the head back into the pelvic cavity
    • When head no longer recedes between contractions = Crowning
      • This indicates that delivery is imminent
  • As crowning occurs - hands of the midwife are used to flex the foetal head and guard the perineum
  • Once the head has crowned woman are discouraged from bearing down
    • Done by telling her to take rapid, shallow breaths
29
Q

What immediate care of the neonate is done?

A
  • Baby will usually take its first breath within seconds
  • No need for immediate clamping
  • After clamping/cutting umbilical cord, baby should have an Apgar score calculated at 1 minute and at 5 minutes
  • The baby’s head should be kept dependent to allow mucus in the respiratory tract to drain
  • Immediate skin-to-skin contact between mother and baby will help bonding and promote release of oxytocin
    • Helps stimulate lactation and bonding between mother and baby
30
Q

What is the Apgar score?

A
  • Scoring system to assess a baby shortly after birth
  • 1 minute and 5 minutes after delivery → every 5 minutes after if condition remains poor
  • >7 is considered normal
31
Q

Describe the Apgar score.

A
  • Appearance, Pulse, Grimace, Activity, Respiration
  • >7 is considered normal
32
Q

What management should the baby receive in the first hour of life?

A
  • Dried and covered with a warm blanket or towel
  • Initiation of breastfeeding should be encouraged
  • Routine measurements of HC, birthweight and temperature
  • The first dose of baby’s vitamin K should be given in the delivery room - must be in first 24 hours
33
Q

What are the causes of PPH?

A
  • Tone (uterine atony; 70%)
  • Trauma (laceration; 20%)
  • Tissue (retained products; 10%)
  • Thrombin (coagulopathy; <1%)
34
Q

Describe active management of 3rd phase of labour.

A
  • 10 IU oxytocin (IM)/ergometrine (only oxytocin if hypertensive)
    • After birth of the anterior shoulder
    • Immediately after delivery (and before the cord is clamped and cut)
  • Clamp the cord between 1-5 mins
  • Controlled cord traction to remove the placenta
    • In 2% of cases, the placenta will not be expelled by this method
    • If no bleeding occurs, another attempt should be made after 10 mins
35
Q

What are the signs of placental separation?

A
  • Gush of blood
  • Cord lengthening
  • Uterus rises
  • Uterus becomes round
36
Q

What is a rare complication of controlled cord traction to remove the placenta?

A

Uterine inversion

37
Q

Describe physiological management of 3rd phase of labour.

A
  • Placenta is delivered by maternal effort with no uterotonic drugs
  • Associated with more bleeding and a greater need for blood transfusions
    • If haemorrhage occurs or the placenta is undelivered after 60 mins = active management should be recommended
38
Q

What needs to be assessed post-delivery of the placenta?

A
  • Inspect placenta for:
    • Missing cotyledons
    • Succenturiate lobe
  • Vulva inspected for tears
39
Q

What is the management of a retained placenta?

A

Examination Under Anaesthetic + MROP (manual removal of placental tissue)

40
Q

What is defined as prolonged 3rd phase of labour?

A
  • Active management = >30 minutes
  • Physiological management = >60 mins → move to active management
41
Q

What methods are available to induce labour?

A
  1. Membrane Sweeping
  2. Preparing the cervix with prostaglandins
  3. Artificial Rupture of Membranes (ARM)
  4. Syntocinon
  5. C-Section
42
Q

Describe membrane sweeping.

A
  • Offered prior to formal induction (not part of induction of labour) → repeat if labour not starting
  • Nulliparous women → offered at 40-41 weeks
  • Multiparous women → offered at 41 weeks
43
Q

Describe preparation of the cervix with prostaglandins.

A
  • Preferred formal method of induction
  • Can be administered as a tablet, gel or pessary
    • Pessary: 1 dose over 24 hours
    • Tablet or Gel: 1 dose, followed by a second dose after 6 hours → max of 2 doses
  • Risk = Uterine hyperstimulation
  • In cases of intrauterine foetal death, misoprostol and mifepristone may be used instead
44
Q

What are the indications for induction of labour?

A
  • Prevention of prolonged pregnancy - offered from 41 weeks
  • Maternal request for exceptional circumstances
  • Intrauterine foetal death
45
Q

When is an induction of labour contra-indicated?

A

Pre-term Pre-labour ROM

Breech/transverse lie

IUGR

Suspected foetal macrosomia

Previous C-section - isn’t completely contra-indicated but is advised against due to increased risk of uterine rupture

46
Q

What is the IOL regimen for intrauterine foetal death?

A
  • If membranes intact → offer induction
  • If rupture of membranes, infection or bleeding → immediate induction
  • Induction regimen = oral mifepristone, followed by prostin or misoprostol
47
Q

What forms of analgesia are available to a women in labour?

A
  • Non-pharmacological methods:
    • TENS
    • Breathing techniques
    • Massage
  • Pharmacological:
    • Entonox (50% NO in O2)
    • Meperidine (pethidine, IM 1mg/kg)
    • Morphine (0.1-0.15mg/kg) or Diamorphine (IM 5-7.5mg)
    • Fentanyl PCA 20μG bolus with 5 min lockout
  • Anaesthetic
    • Lumbar epidural - bupivacaine, ropivacaine, levobupivacaine, chloroprocaine
    • Combined lumbar spinal-epidural - fentanyl 10-25mcg ± bupivacaine 2.5mg
48
Q

What are the side effects to baby from opioid analgesia in labour?

A
  • Sleepy baby
  • Low RR
49
Q

Define Puerperal pyrexia.

A

>38oC in the first 14 days following delivery

50
Q

What are the causes of puerperal pyrexia?

A
  • Endometritis
  • Wound infection (tear, CS)
  • UTI
  • VTE
  • Mastitis
51
Q

What is the management of puerperal pyrexia?

A
  • IV Clindamycin AND IV Gentamicin until >24hrs without fever

Y5 O&G (69 decks)

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