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Med Finals - Womens Health > Labour > Flashcards

Labour Flashcards

1
Q

Clinical signs of labour

A

Show - mucus plug
Rupture of membranes
Regular painful contractions
Dilating cervix

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2
Q

Define prelabour rupture of membranes

A

The amniotic sac ruptures before onset of labour

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3
Q

Define preterm prelabour rupture of membranes

A

Amniotic sac ruptured before onset of labour and before 37 weeks gestation

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4
Q

Define prolonged rupture of membranes

A

Amniotic sac ruptures more than 18 hours before delivery

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5
Q

Define prematurity

A

Birth before 37 weeks gestation.
Non-viable below 23 weeks

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6
Q

Prophylaxis of preterm labour

A

Vaginal progesterone
Cervical cerclage
Offered to those with cevical length less than 25mm on ultrasound at 16-24 weeks

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7
Q

Management of premature rupture of membranes

A

Prophylactic antibiotics
Induction of labour
Steroirds?

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8
Q

Management of preterm labour with no rupture

A

Fetal monitoring
Tocolysis - nifedipine
Maternal corticosteroids
IV magnesium sul[hate
Delayed cord clamping

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9
Q

Define tocolysis

A

Using medication to stop uterine contration

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10
Q

Options for tocolysis

A

Nifedipine - 1st
Atosiban - oxytocin receptor antagonist

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11
Q

When can tocolysis be used

A

Between 24-33+6 week in preterm labour - especially without ruptured membranes

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12
Q

Purpose of antenatal steroids

A

Aid fetal lung development
Prevent respiratory distress syndrome

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13
Q

Purpose of antenatal magnesium sulphate

A

Portect fetal brain -

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14
Q

Indications for indduction of labour

A

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death
Over due

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15
Q

Score used to determin if induction is necessary

A

Bishop score

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16
Q

Options for induction of labour

A

Membrane sweep
Vaginal prostaglandin pessary
Cervical ripening balloon
Artificial rupture of membranes
Oral mifepristone

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17
Q

Complication of labour induction

A

Uterine hyperstimulation - prolonged and frequent contraction of the uterus - lots of monitoring

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18
Q

Define CTG

A

Cardiotocography - measures fetal heart rate and contractions of the uterus

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19
Q

Indications for CTG

A

Sepsis
Maternal tachycardia
Significant meconium
Pre-eclampsia
Fresh antepartum haemorrhage
Delay in labour
Use of oxytocin
Disproportionate maternal pain

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20
Q

Key features on CTG

A

Contraction - per 10 minutes
Baseline rate - fetal HR
Variability - HR rises and falls with contractions
Acceleration - HR spike
Deceleration - HR drops

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21
Q

Baseline rate measurements

A

Reassuring - 110-160
Non-reassuring - 100-109 or 161-180
Abnormal - <100 or >180

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22
Q

Variability measurements

A

Reassuring 5-25
Non-reassuring - <5 for 30-50 minutes or >25 for 15-25 minutes
Abnormal - <5 for over 50 mins or >25 for over 25 minutes

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23
Q

Define early deceleration

A

Gradual drops in HR that correspond to uterine contraction - normal and not pathological

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24
Q

Define late decelerations

A

Gradual falls in HR that starts after uterine contractions have begun - lowest point is after peak of contraction.
More concerning - caused by hypoxia as a result of excessive uterine contraction, maternal hypotension or maternal hypoxia

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25
Define variable decelerations
Abrupt decelerations that may be unrelated to uterine contraction - fall of more than 15 from baseline. Indicate intermittent compression of umbilical cord causing hypoxia
26
Define prolonged decelerations
Last between 2 and 10 minutes with a drop of more than 15 from baseline 0 indicated compression of umbilical cord causing hypoxia
27
When is a CTG reassuring
When there are no decelerations, a good baseline, some variability and may be accelerations
28
How to assess a CTG
DR C BRaVADO Define Risk - maternal and pregnancy related Contraction Baseline Rate Variabiloty Accelerations Deceleration Overall impression
29
Catogories of CTG
Normal Suspicious PAthologcial Need for urgent intervention
30
Indications for oxytocin infusion
Iduction of labour Progression of labour Improve frequency and strength of contraction Prevent post partum haemorrhage
31
Define failure to progress
When labour is not developing at a satisfactory rate
32
Duration for failure to progress in 1st stage
- latent - 0-3cm -0.5cm per hour - active - 3-7cm - 1cm per hour - transition - 7-10cm - 1 cm per hour Delay consider when <2cm in 4 hours or slowing of progress in multiparous women
33
Duration for failure to progress in 2nd stage
10cm to delivery of baby 2 hour in nuliparous 1 hour in multiparous
34
Duration for failure to progress in 3rd stage
Baby delivered to placenta delivered more 30 minutes with active management More than 60 minutes with physiological management
35
Management of failure to progress
Amniotomy Oxytocin infusion Instrumental delivery Caesarean section
36
Options for pain relief in labour
Simple - paracetamol, codeine Gas and air IM pethidine or diamorphine Patient controlled - remifentanil Epidural
37
Define umbilical cord prolapse
When the umbilical cord descends below the presenting part of the foetus and through the cervix into the vagina - after rupture of membranes
38
Management of umbilical cord prolapse
Push presenting/compressing part upward and emergency c section
39
Define shoulder dystocia
When the anterior shoulder of the baby becomes stuck behin the pubic symphysis of the pelvis after the head has been delivered
40
Presentation of shouolder dystocia
Delivery of face and head and obstruction in shoulder delivery Failure of restitution Turtle-neck sign - head delivered but then retracts into vagina
41
Management of shoulder dystocia
Episiotomy McRoberts manoeuvre Pressure to the anterior shoulder Rubins manoeuvre Wood's screw manoeuvre Zavanelli manoeuver - push head back in and c section
42
Indications for instrumental delivery
Failure to progress Fetal distress Maternal exhaustion Control of the head in various fetal positions
43
Risks to mother of instrumental deliver
Post partum haemorrhage Episiotomy Perineal tears Injury to the anal sphincter Incontinence of bladder or bowel Nerve injury
44
Risks to baby in instrumental delivery
Cephalohematoma - ventouse Facial nerve palsy - forceps Subgaleal haemorrhae Intracranial haemorrhage Skull fracture Spinal cord injury
45
Risk factors for perineal tears
First births LArge babies Shoulder dystocia Asian Occipito-posterior position Instrumental deliveries
46
Define 1st degree tear
injury limited to the frenulum of the labia and superficial skin
47
Define 2nd degree tear
Including the perineal muscles but not affecting the anal sphincter
48
Define 3rd degree tear
Inclusing the anal sphincter but not affecting the rectal mucosa
49
Define 3rd degree tear
Inclusing the anal sphincter but not affecting the rectal mucosa
50
Define 4th degree tear
Including rectal mucosa
51
Management of perineal tears
Broard spectrum antibiotic Laxatives Physio Follow up 1st - no suture 2nd - suture 3/4th - consider repair in theatre
52
Indications for elective c section
Previous caesarean Symptomatic after previous significant perineal tear Placenta praevia Vasa praevia Breech presentation Multiple pregnancy Uncontrolled HIV infection Cervical cancer
53
Define category 1 c section
Immediate threat to the life of mother or baby - decision to delivery time 30 mins
54
Define category 2 c section
No imminent threat to life but c section is require due to compromise of mother or baby Decision to delivery 75 minutes
55
Define category 3 c section
Delivery is require but mother and baby are stable
56
Define category 4 c section
Elective c section
57
Define maternal sepsis
Condition where the body launches a large immune response to an infection causing systemic inflammation affecting the fuction of the organs of the body
58
Main causes of sepsis in pregnancy
Chrioamnionitis UTI
59
Define chorioamnionitis
Infection of the chrioamniotic membranes and amniotic fluid - leading cause of maternal sepsis (and death)
60
Presentation of chorioamnionitis
Abdominal pain Uterine tenderness Vaginal discharge Fever Tachycardia Raised O2 Low blood pressure Altered consciousness reduced urine output Raised wcc Evidence of fetal compromise
61
Management of maternal sepsis
Sepsis 6 Close maternal and fetal monitoring Early deliver - emergency c section (general anaesthesia) Antibiotics - local! Tazocin, plus gent or amoxicillin
62
Sepsis 6
Blood cutures Blood gas Urine output Oxygen Fluid Antibiotics
63
Define amniotic fluid embolism
Where amniotic fluid passes into the mothers blood - occurs during labour Fluid contains fetal tissue so immue responce causes systemic inflammation
64
Risk factors for amniotic fluid embolism
Age Induction of labour Caesarean section Multiple pregnancy
65
Presentation of amniotic fluid embolism
Around labour - can be post partum Similar to sepsis or PE or anaphylaxis Shortness of breath Hypoxia Hypotension Coagulopathy Haemorrhage Tachycardia Confusion Seizures Cardiac arrest
66
Management of amniotic fluid embolissm
ABCDED Often ITU
67
Define uterine rupture
Complication of labour where the muscle layer of the uterus (myometrium) rupture.
68
Risk factors for uterine rupture
Previous c section Vaginal birth after c section! Previous uterine surgery Increased BMI High parity Age Labour Oxytocin
69
Presentation of uterine rupture
Abnormal CTG Abdominal pain Vaginal bleeding Ceasing of uterine contractions Hypotension Tachycardia COllapse
70
Management of uterine rupture
Resus Transfusion Emergency c section
71
Define uterine inversion
Where the fundus of the uterus drops down through the uterine cavity and cervix
72
Presentation of uterine inversion
Large postpartum haemorrhage Maternal shock or collapse
73
Management of uterine inversion
Johnson manoeuvre Hydrostatic methods Surgery

Med Finals - Womens Health (10 decks)

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