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Reproduction > Labour > Flashcards

Labour Flashcards

1
Q

What is labour?

A
  • physiological process during which the fetus membranes, umbilical cord and placenta are expelled from uterus
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2
Q

What are the initiation factors of labour?

A
  • decreased progesterone
  • oestrogen causes contraction and prostaglandin release
  • prostaglandins ripen the cervix
  • oxytocin causes contraction and stimulates prostaglandings
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3
Q

What is the Ferguson’s reflex?

A
  • neuroendocrine reflex of pressure on cervix causing increased contractions
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4
Q

Explain cervical changes during labour?

A
  • decrease in collagen fibre alignment
  • decrease in collagen fibre strength
  • decrease in tensile strength
  • increase in cervical decorin
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5
Q

What scoring system is used for labour?

A
  • Bishop’s score

- likelihood of labour

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6
Q

What does the Bishop’s score include?

A
  • position
  • consistency
  • effacement
  • dilation
  • station in pelvis
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7
Q

Bishops score of 4 or less??

A
  • indicates an unfavourable cervix

- requires ripening

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8
Q

What does a cervical assessment in labour include?

A
  • effacement
  • dilation
  • firmness
  • position
  • level
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9
Q

What is polarity?

A
  • upper segment contracts and retracts

- lower cervix is stretched dilated and relaxed

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10
Q

Stages of labour?

A
  • 1st
  • 2nd
  • 3rd
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11
Q

explain the 1st stage of labour?

A
  • latent and active

- slow descent of presenting part

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12
Q

Explain the 2nd stages of labour

A
  • starts when the cervix is completely dilated to 10cm

- may last < 3hrs in nulliparous and < 2hrs in multiparrous

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13
Q

3rd stage of labour?

A
  • delivery of the baby and expulsion of the placenta
  • if > 1 hr = surgical
  • oxytocin given as active management
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14
Q

2 factors that affect contraction?

A
  • power

- passage (shape of pelvis)

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15
Q

Where is the location of the pacemaker of contraction?

A
  • tubal ostia
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16
Q

What is normal fetal position in labour?

A
  • longitudinal lie

- cephalic presentation

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17
Q

Analgesia for labour?

A
  • paracetamol / co-codamol
  • TENS
  • Entonox (inhalation)
  • diamorphine IM
  • epidural anaesthesia
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18
Q

What is a partogram?

A
  • graphic record of process of labour
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19
Q

What is the puerperium period?

A
  • 6 weeks post- birth
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20
Q

What can be used to determine fetal position during labour?

A
  • fontanelles
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21
Q

7 cardinal movements in labour?

A
  • engagement
  • decent
  • flexion
  • internal rotation
  • crowning and extension
  • restitution and external rotation
  • expulsion
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22
Q

What is the purpose of delayed cord clamping?

A
  • better for baby’s blood cells

- up to 3 mins

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23
Q

Explain placental separation?

A
  • seperation of decidua basalia
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24
Q

normal blood loss in pregnancy?

A
  • normal = 500mls

- significant > 1000mls

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25
Q

What hormone stimulates lactation?

A
  • prolactin
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26
Q

What is colostrum rich in?

A
  • immunoglobulins
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27
Q

Explain the steps in parturition?

A
  • fetal stress -> ACTH -> Cortisol
  • cortisol -> decrease in progesterone and oestrogen and increase in prostaglandins
  • prostaglandins -> ripening and contraction
  • Fergusons reflex -> oxytocin release
  • oxytocin -> contraction
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28
Q

Where is oxytocin released from and what does it cause?

A
  • released in response to cervical stretch (Ferguson’s reflex)
  • causes contraction of uterus and production of more prostaglandins
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29
Q

What is the role of cortisol in labour?

A
  • decreased progesterone
  • decreased oestrogen
  • increased prostaglandins
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30
Q

What defines pre-term and overdue baby?

A
  • pre-term < 37 weeks

- overdue > 42weeks

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31
Q

What is the vertex?

A
  • area bounded by anterior and posterior fontanelles and the parietal eminences
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32
Q

Define malposition?

A
  • non-vertex
  • breech
  • transverse
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33
Q

Assessment in labour includes what?

A
  • cervical dilation
  • descent of presenting part
  • any signs of obstruction
  • assessed every 4hrs
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34
Q

What may be signs of labour obstruction?

A
  • moulding
  • caput
  • anuria
  • haemturia
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35
Q

Aetiology of pain in labour?

A
  • compression of para-cervical nerves

- myometrial hypoxia

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36
Q

Explain an epidural anaethetic

A
  • needle and catheter into epidural space
  • doesn’t affect uterine contractility
  • may affect motility
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37
Q

Complications of an epidural anaesthetic?

A
  • hypotension
  • dural puncture
  • headache
  • slow stage 2

prim

  • no epidural = 2hr
  • epidural = 3hr

multi

  • no epidural = 1hr
  • epidural = 2hr
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38
Q

Define failure to progress?

A
  • <2cm dilation in 4hr
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39
Q

Obstructed labour may have what complications?

A
  • sepsis
  • uterine rupture
  • obstructed AKI
  • Fistula
  • postpartum haemorrhage
  • fetal asphyxia
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40
Q

When should a partogram be commenced?

A
  • 4cm dilation

- active labour

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41
Q

What is a partogram and what does it include?

A
  • graphic representation of progress of labour

- heart rate, amniotic fluid, dilation, descent, contraction, obstruction, maternal observations

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42
Q

What are the 2 prefilled lines on a partogram/

A
  • alert line

- action line

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43
Q

What intrapartum assessment of the fetus is conduced and when?

A
  • doppler (stage 1 every 15mins, stage 2 every 5mins)
  • CTG
  • colour of amniotic fluid
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44
Q

Normal fetal heart rate?

A
  • norma 110-150
  • tachy > 150
  • Brady <110
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45
Q

Signs of fetal hypoxia on CTG?

A
  • Loss of accelerations
  • deeper decelerations
  • rising fetal heart rate
  • loss of variability
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46
Q

Interpretation of CTG?

A
  • DR C BRAVADO
  • Determine
  • Risk
  • contractions
  • baseline
  • rate
  • variability
  • accelerations
  • decelerations
  • overall impressuon
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47
Q

Acute causes of fetal hypoxia?

A
  • uterine hyperstimulation
  • abruption
  • cord prolapse
  • uterine rupture
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48
Q

chronic cause of fetal hypoxia?

A
  • placental insufficiency

- fetal anaemia

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49
Q

When might operative vaginal delivery be offered and what does it include?

A
  • only if fully dilated cervix
  • delay, fetal concern, special indications
  • forceps
  • ventouse
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50
Q

Explain ventouse

A
  • vaginal operative management
  • less damage to perineum than forceps
  • higher failure rate
  • contraindicated in : < 34weeks, blood disorder, HIV, Hep B
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51
Q

Risk in Caesarean section?

A
  • sepsis
  • haemorrhage
  • VTE
  • Subfertility
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52
Q

Caput succedaneum vs cephalohaematoma

A
  • caput succedaneum = crosses suture lines, present at birth due to pressure at cervix
  • cephalohaematoma = due to instruments, confined to sutures
53
Q

Define the blood loss for post-partum haemorrhage?

A
  • SVD > 500ML
  • Operative vaginal > 750ml
  • c-section >1,00ml
54
Q

Causes of post-partum haemorrhage?

A
  • 4 T’s
  • tone (uterine atony)
  • tissue
  • trauma
  • thrombin
55
Q

Management of post-partum haemorrhage

A
  • ABCDE
  • Oxytocin (syntocinon)
  • ergometrine
  • carbaprost
  • misoprostol
56
Q

Further management for failed attempt in post-partum haemorrhage?

A
  • intrauterine balloon

- hysterectomy

57
Q

Physiological Management of 3rd stage?

A
  • up to 60mins
  • maternal effort
  • reduced side effects
  • increased chance of pph
58
Q

Active management of 3rd stage of labour

A
  • up to 30mins
  • oxytocin
  • syntometerine
  • cord clamped an pulled
59
Q

Explain a retained placenta?

A
  • due to uterine atony, cord snapping or morbidly adherent placent
60
Q

Complication of a retained placenta

A
  • haemorrhage

- uterine inversion

61
Q

Risk factors for shoulder dystocia?

A
  • previous dystocia
  • bmi > 30
  • short stature
  • instrumental delivery
  • fetal macrosomia
62
Q

Complications of shoulder dystocia

A
  • brachial nerve injury
  • fracture clavicle
  • hypoxia
  • PPH
  • Pelvic injury
  • death
63
Q

Management of shoulder dystocia?

A
  • HELPERR
  • Help
  • episiotomy
  • legs (mcroberts)
  • pressure subrapubic
  • enter and rotate
  • remove posterior arm
  • roll onto knees
64
Q

How are perineal tears graded

A
  • 1st degree to 4th degree
65
Q

Risk factors for post-partum sepsis?

A
  • anaemia
  • prolonged rupture of membranes
  • long labour
  • assisted delivery
66
Q

Potential site of infection in postpartum sepsis?

A
  • skin/wound
  • uterus (endometritis)
  • urine
  • chest
  • breast
67
Q

Management of post-partum sepsis?

A
  • sepsis 6
  • o2 and sats >94%
  • blood culture
  • broad IV antibiotics
  • fluids
  • measure lactate
  • measure urine
68
Q

Symptoms of a rubella infection?

A
  • fever
  • macuopapular rash
  • lymphadenopathy
  • polyarthritis
69
Q

Birth defects associated with rubella?

A
  • cataracts
  • microcephaly
  • cardiac abnormalities
  • deafness
70
Q

MMR vaccine in pregnancy?

A
  • avoid pregnancy for 4 weeks

- live vaccine

71
Q

What virus causes measles?

A
  • paramyoxovirus
72
Q

Symptoms of measles

-

A
  • fever
  • koplik spots (white spots on mucosa)
  • red runny eyes
  • runny nose
73
Q

Symptoms of chicken pox?

A
  • fever
  • malaise
  • vesicular rash
74
Q

Management of chicken pox?

A
  • check VZV immunity
  • supportive
  • aciclovir if > 20weeks
75
Q

Complications of chicken pox in pregnancy?

A
  • early pregnancy = fetal varicella syndrome

- later = neonatal chicken pox

76
Q

Symptoms of fetal varicella syndrome?

A
  • limb abnormality

- microcephaly

77
Q

When is CMV greatest risk in pregnancy?

A
  • later trimesters
78
Q

What management in CMV in pregnancy

A
  • USS every 2 weeks

- fetal brain MRI

79
Q

Treatment of CMV

A
  • anti-virals
80
Q

Complications of parvovirus in pregnancy

A
  • aplastic anaemia
  • congenital heart failure
  • hydrops
81
Q

When is parvovirus most at risk in pregnancy?

A
  • early pregnancy
82
Q

Management of parvovirus in pregnancy?

A
  • USS

- Fetal MCA doppler (due to aplastic anaemia)

83
Q

Zika virus defects?

A
  • brain defects
  • microcephaly
  • hearing and vision problems
84
Q

What type of HSV is greatest risk to pregnancy?

A
  • primary infection
85
Q

PEP in HIV in pregnancy?

A
  • post-exposure prophylaxis for 2-4 weeks

- HAART 3 drugs

86
Q

Raw/undercooked meat associated with what?

A
  • toxoplasmosis
87
Q

Complications of toxoplasmosis in pregnancy?

A
  • hydrocephalus
  • choriorenitis
  • cerebral calcifications
88
Q

Treatment of toxoplasmosis?

A
  • spiramycin
89
Q

Why is soft cheese and un-pasturised milk avoided in pregnancy?

A
  • listeriosis
90
Q

Treatment of listeriosis?

A
  • ampicillin + gentamicin
91
Q

Reversible causes of cardiac arrest?

A
  • hypoxia
  • hypovolaemia
  • hypo/hyper glycaemia
  • hypothermia
  • thromboembolism
  • tamponade
  • toxins
  • tension pneumothorax
  • eclampsia
  • intracerebral haemorrhage
92
Q

Explain aortocaval compression

A
  • from 20weeks gestation IVC and aorta at risk of compression
  • manual uterine displacement
93
Q

Explain perimorteum c-section

A
  • prepare after 4 mins CPR

- Perform after 5 mins CPR

94
Q

Cord prolapse?

A
  • associated with malpresentation
  • hypoxia due to compression
  • immediate delivery
95
Q

What defines bleeding in early pregnancy?

A
  • less than 24weeks
96
Q

Causes of haemorrhage in pregnancy?

A
  • placental abruption
  • placenta praevia
  • atony
  • delayed manual removal of placenta
  • genital tract trauma
97
Q

Functions of the placenta?

A
  • gas transfer
  • metabolism
  • hormone production
  • protective filter
98
Q

Define antepartum haemorrhage

A
  • bleeding from 24 weeks to end of second stage of labour
99
Q

Causes of antepartum haemorrhage?

A
  • placental abruption
  • placenta praevia
  • uterine rupture
  • infection
  • uterine problems (polyps)
100
Q

What is a placental abruption?

A
  • sudden separation of a normal placenta
101
Q

Pathology of placental abruption?

A
  • vasospasm followed by arteriole rupture into the decidua
  • uterine contraction
  • hypoxia
102
Q

Signs of placental abruption?

A
  • bleeding (may be concealed)
  • abdominal pain
  • tender woody uterus
  • fetal compromise
103
Q

Treatment of placental abruption?

A
  • ABCDE
  • Resusitation of mother
  • deliver baby
104
Q

Complications of placental abruption?

A
  • hypovolaemic shock
  • anaemia
  • PPH
  • fetal hypoxia
  • fetal death
105
Q

What is placenta praevia?

A
  • low lying placenta

- lies directly over the internal os

106
Q

Risk factors of placenta praevia?

A
  • previous c-section
  • termination of pregnancy
  • maternal age >40
107
Q

Signs of placenta praevia?

A
  • painless bleeding > 24 weeks
  • usually provoked by sex
  • uterus soft and non-tender
  • presenting part high
108
Q

Warning in suspected placenta praevia?

A
  • DO NOT do vaginal examination until proven otherwise
109
Q

How is a baby generally delivered in placenta praevia?

A
  • c-section
110
Q

What is placenta accreta?

A
  • morbidity adherent placenta to uterine wall
111
Q

Differentiating placenta praevia and accreta?

A
  • MRI
112
Q

Signs of uterine rupture?

A
  • severe abdominal pain
  • shoulder tip pain
  • maternal collapse
  • PV bleeding
113
Q

Vasa paevia?

A
  • unprotected fetal vessels below presenting part over internal cervical os
  • ruptures during labour or amniotomy
114
Q

Diagnosing vasa praevia?

A
  • USS
115
Q

Define secondary post-partum haemorrhage?

A
  • after 24hrs up to 6 weeks
116
Q

What is Kleihauer - Betke test?

A
  • blood test to measure amount of fetal haemoglobin in maternal blood stream
  • used for APH in rhesus negative mums
117
Q

Risk of maternal sepsis?

A
  • pre-natal invasive diagnostic procedures
  • cervical suture
  • prolonged rupture of membranes
  • operative delivery
118
Q

Signs of maternal infection

A
  • offensive Dischagrge loss
  • sore throat
  • rash
  • abdominal pain
  • urinary frequency
119
Q

Main antibiotic used in sepsis?

A
  • IV co-amoxiclav

+/- gentamicin
clindamycin + gentamicin if pen allergic

120
Q

Explain chorioamnionitis?

A
  • inflammation of the amniochorionic membranes
  • microbial invasion
  • 96% ascending infection
121
Q

Commonest bacteria in chorioamnionitis?

A
  • e.coli

- mycoplasma

122
Q

When to suspect chorioamnionitis?

A
  • not yet delivered baby
    signs of sepsis
  • offensive PV
  • fetal distress
123
Q

Endometritis?

A
  • infection of uterine lining
124
Q

Signs of endometritis?

A
  • abdominal pain
  • abnormal PV bleeding
  • offensive PV discharge
125
Q

Treatment of endometritis?

A
  • co-amoxiclav
126
Q

Signs of mastitis?

A
  • unilateral painful and inflamed breast
127
Q

Treatment of mastitis?

A
  • complete emptying
  • warm compresses
  • NSAIDs
  • flucloxacillin
128
Q

Signs of an epidural abscess?

A
  • back pain or fever

- neurological deficit

129
Q

How is an epidural abscess diagnosed?

A
  • MRI

Reproduction (25 decks)

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