Labour Flashcards
What is labour?
A physiological process in which the foetus, membranes, umbilical cord and placenta are expelled from the uterus.
What hormones are involved in labour?
Progesterone
Oestrogen
Oxytocin
What is crucial in allowing the cervix to dilate?
Cervical softening
When does the 2nd stage of labour begin?
When the cervix is fully dilated.
What is the best shape of pelvis to aid delivery of a foetus?
Gynaecoid
Is the diameter of the pelvic inlet the same as the pelvic outlet?
No
What is expulsed from the vagina first during delivery?
Head and then the anterior shoulder of the foetus.
Should clamping of the umbilical cord be carried out ASAP?
No, delay of this maximises the RBC supply at birth.
For how long is skin-to-skin contact recommended following birth?
Atleast an hour.
What can be given to aid expulsion of the placenta in the 3rd stage of pregnancy?
Syntometerine
What is a normal amount of blood to lose during pregnancy?
Around 500ml.
If over 1 litre - this is bad.
What is the puerperium?
The period of recovery and repair following pregnancy.
What is defined as preterm labour?
That occurring prior to 37 weeks gestation.
What is defined as post-term labour?
That occurring after 42 weeks gestation.
What is the most effective anaesthesia available in pregnancy?
Epidural
How is progression of labour assessed?
Cervical dilatation
Descent of the presenting part
Monitoring for signs of obstruction
What is the expected rate of progression during labour?
2cm every 4 hours.
What is the most common reason for failure to progress during labour?
Deflexion of the foetal head.
What is a partogram?
A graphic representation of labour progress.
What is post-partum haemorrhage?
Any blood loss > 500ml in the 24 hours following birth.
When is a PPH described as a major PPH?
If 1000ml of blood is lost.
At what % blood loss does BP begin to drop?
Over 30%.
This is a late sign.
What are the 4 ‘T’s responsible for PPH?
Tone
Trauma
Tissue
Thrombin
What is the most common cause of PPH?
Uterine atony
Uterus fails to contract down following labour. This results in vessels remaining open, therefore bleeding occurs.
How is PPH managed?
‘ABCDE’
Uterotonic drugs
Tranexamic acid
What are examples of uterotonic drugs?
Oxytocin
Ergometrine
Carboprost
Misoprostol
What is the action of uterotonic agents?
To initiate uterine contraction.
What is the first-line surgical management of PPH?
Intrauterine balloon
What is a complication of a morbidly adherent placenta?
Uterine inversion - can lead to prolapse.
This is an obstetric emergency.
What is shoulder dystocia?
When the shoulders of the foetus do not pass following the head, becoming wedged behind the mother’s pubic symphysis.
What may result from shoulder dystocia?
Irreversible injury to the brachial plexus.
Is genital tract trauma common in pregnancy?
Yes, occurs in 95% of first-time mothers.
What is the most common cause of post-partum sepsis?
Infection of the uterus (called endometritis).
what are risk-factors for post-partum sepsis?
Prolonged rupture of membranes
Use of instruments during labour
Tissue left within the womb following delivery
how is sepsis managed?
Give O2, keep sats >94% Take blood culture Give IV antibiotics (usually co-amoxiclav) Give fluid challenge Measure lactate Measure urine output
Think sepsis ‘6’.
In those with a penicillin allergy, what is given instead of co-amoxiclav in the treatment of sepsis?
Clindamycin and gentamicin.
Both given intravenously.
