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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
Q

Define variable decelerations

A

Abrupt decelerations that may be unrelated to uterine contraction - fall of more than 15 from baseline.
Indicate intermittent compression of umbilical cord causing hypoxia

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26
Q

Define prolonged decelerations

A

Last between 2 and 10 minutes with a drop of more than 15 from baseline 0 indicated compression of umbilical cord causing hypoxia

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27
Q

When is a CTG reassuring

A

When there are no decelerations, a good baseline, some variability and may be accelerations

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28
Q

How to assess a CTG

A

DR C BRaVADO
Define Risk - maternal and pregnancy related
Contraction
Baseline Rate
Variabiloty
Accelerations
Deceleration
Overall impression

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29
Q

Catogories of CTG

A

Normal
Suspicious
PAthologcial
Need for urgent intervention

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30
Q

Indications for oxytocin infusion

A

Iduction of labour
Progression of labour
Improve frequency and strength of contraction
Prevent post partum haemorrhage

31
Q

Define failure to progress

A

When labour is not developing at a satisfactory rate

32
Q

Duration for failure to progress in 1st stage

A
  • 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
Q

Duration for failure to progress in 2nd stage

A

10cm to delivery of baby
2 hour in nuliparous
1 hour in multiparous

34
Q

Duration for failure to progress in 3rd stage

A

Baby delivered to placenta delivered
more 30 minutes with active management
More than 60 minutes with physiological management

35
Q

Management of failure to progress

A

Amniotomy
Oxytocin infusion
Instrumental delivery
Caesarean section

36
Q

Options for pain relief in labour

A

Simple - paracetamol, codeine
Gas and air
IM pethidine or diamorphine
Patient controlled - remifentanil
Epidural

37
Q

Define umbilical cord prolapse

A

When the umbilical cord descends below the presenting part of the foetus and through the cervix into the vagina - after rupture of membranes

38
Q

Management of umbilical cord prolapse

A

Push presenting/compressing part upward and emergency c section

39
Q

Define shoulder dystocia

A

When the anterior shoulder of the baby becomes stuck behin the pubic symphysis of the pelvis after the head has been delivered

40
Q

Presentation of shouolder dystocia

A

Delivery of face and head and obstruction in shoulder delivery
Failure of restitution
Turtle-neck sign - head delivered but then retracts into vagina

41
Q

Management of shoulder dystocia

A

Episiotomy
McRoberts manoeuvre
Pressure to the anterior shoulder
Rubins manoeuvre
Wood’s screw manoeuvre
Zavanelli manoeuver - push head back in and c section

42
Q

Indications for instrumental delivery

A

Failure to progress
Fetal distress
Maternal exhaustion
Control of the head in various fetal positions

43
Q

Risks to mother of instrumental deliver

A

Post partum haemorrhage
Episiotomy
Perineal tears
Injury to the anal sphincter
Incontinence of bladder or bowel
Nerve injury

44
Q

Risks to baby in instrumental delivery

A

Cephalohematoma - ventouse
Facial nerve palsy - forceps

Subgaleal haemorrhae
Intracranial haemorrhage
Skull fracture
Spinal cord injury

45
Q

Risk factors for perineal tears

A

First births
LArge babies
Shoulder dystocia
Asian
Occipito-posterior position
Instrumental deliveries

46
Q

Define 1st degree tear

A

injury limited to the frenulum of the labia and superficial skin

47
Q

Define 2nd degree tear

A

Including the perineal muscles but not affecting the anal sphincter

48
Q

Define 3rd degree tear

A

Inclusing the anal sphincter but not affecting the rectal mucosa

49
Q

Define 3rd degree tear

A

Inclusing the anal sphincter but not affecting the rectal mucosa

50
Q

Define 4th degree tear

A

Including rectal mucosa

51
Q

Management of perineal tears

A

Broard spectrum antibiotic
Laxatives
Physio
Follow up
1st - no suture
2nd - suture
3/4th - consider repair in theatre

52
Q

Indications for elective c section

A

Previous caesarean
Symptomatic after previous significant perineal tear
Placenta praevia
Vasa praevia
Breech presentation
Multiple pregnancy
Uncontrolled HIV infection
Cervical cancer

53
Q

Define category 1 c section

A

Immediate threat to the life of mother or baby - decision to delivery time 30 mins

54
Q

Define category 2 c section

A

No imminent threat to life but c section is require due to compromise of mother or baby
Decision to delivery 75 minutes

55
Q

Define category 3 c section

A

Delivery is require but mother and baby are stable

56
Q

Define category 4 c section

A

Elective c section

57
Q

Define maternal sepsis

A

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
Q

Main causes of sepsis in pregnancy

A

Chrioamnionitis
UTI

59
Q

Define chorioamnionitis

A

Infection of the chrioamniotic membranes and amniotic fluid - leading cause of maternal sepsis (and death)

60
Q

Presentation of chorioamnionitis

A

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
Q

Management of maternal sepsis

A

Sepsis 6
Close maternal and fetal monitoring
Early deliver - emergency c section (general anaesthesia)
Antibiotics - local! Tazocin, plus gent or amoxicillin

62
Q

Sepsis 6

A

Blood cutures
Blood gas
Urine output
Oxygen
Fluid
Antibiotics

63
Q

Define amniotic fluid embolism

A

Where amniotic fluid passes into the mothers blood - occurs during labour
Fluid contains fetal tissue so immue responce causes systemic inflammation

64
Q

Risk factors for amniotic fluid embolism

A

Age
Induction of labour
Caesarean section
Multiple pregnancy

65
Q

Presentation of amniotic fluid embolism

A

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
Q

Management of amniotic fluid embolissm

A

ABCDED
Often ITU

67
Q

Define uterine rupture

A

Complication of labour where the muscle layer of the uterus (myometrium) rupture.

68
Q

Risk factors for uterine rupture

A

Previous c section
Vaginal birth after c section!
Previous uterine surgery
Increased BMI
High parity
Age
Labour
Oxytocin

69
Q

Presentation of uterine rupture

A

Abnormal CTG
Abdominal pain
Vaginal bleeding
Ceasing of uterine contractions
Hypotension
Tachycardia
COllapse

70
Q

Management of uterine rupture

A

Resus
Transfusion
Emergency c section

71
Q

Define uterine inversion

A

Where the fundus of the uterus drops down through the uterine cavity and cervix

72
Q

Presentation of uterine inversion

A

Large postpartum haemorrhage
Maternal shock or collapse

73
Q

Management of uterine inversion

A

Johnson manoeuvre
Hydrostatic methods
Surgery

Med Finals - Womens Health (10 decks)

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