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Gynaecology > Labour > Flashcards

Labour Flashcards

1
Q

Latent phase of labour observations? (5)

A

4 - 6 hourly

  • bp
  • pulse
  • temperature
  • Pv: dilatation, cervical length, membranes, foetal head position, kaput + moulding
  • Rr

2 hourly

  • foetal heart rate
  • contractions

Urine when passed ‘

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2
Q

Define active labour

A

Cervical dilatation 4 cm or more

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3
Q

Active phase of labour observations? (7)

A

4 hourly

  • temperature
  • rr

2 hourly

  • pv
  • head above brim

1 hourly

  • bp
  • pulse

Half hourly

  • foetal heart
  • contractions

Urine when passed

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4
Q

Define second stage labour and duration

A

Cervix fully dilated until delivery

First phase: full dilatation → desire to bear down
Second phase: desire to bear down → active pushing/delivery

PRIMI up to 3h
Multi up to 2

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5
Q

Second stage of labour observations? (2)

A
  • Foetal heart after every 2nd contraction
  • Pv every 15 minutes to assess decent
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6
Q

Oxytocin regimen for augmentation of labour? (4)

A
  • 5 u oxytocin to 1 l ringers
  • start infusion 25 ml /hour
  • increase infusion by 50 ml /h every 30 min (50,100, 150, 200) until 3-4 strong contractions > 40 sec
  • if reaches 200 ml /h and still not strong contractions, increase dose by starting infusion 10 u in 1 L at 150 ml /h, increasing to 200 if necessary
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7
Q

Management abnormal foetal heart / contraction pattern after oxytocin infusion in labour? ((4)

A
  • Stop infusion. Replace line with ringers.
  • No improvement: salbutamol 500 ug/ml injection preparation. 250 ug as a single injection. Give slowly iv over 5 minutes
  • continuous foetal, monitoring.
  • c/s if no improve
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8
Q

Name 2 signs shoulder dystocia

A
  • Turtle sign: retraction of delivered foetal head against perineum
  • inability to deliver foetal shoulders with routine traction in axial direction
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9
Q

Name 8 antepartum risk factors shoulder dystocia

A
  • Multiparity
  • post term gestation
  • maternal obesity
  • maternal diabetes
  • Prior shoulder dystocia
  • prior macrosomic child
  • excess gestational weight gain
  • foetal macrosomia
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10
Q

Name 6 intrapartum risk factors shoulder dystocia

A
  • Induction/augmentation labour
  • abnormal labour
  • prolonged 1st stage
  • prolonged 2nd stage
  • epidural
  • operative vaginal delivery
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11
Q

Name 2 maternal complications shoulder dystocia

A
  • Serious vaginal laceration
  • Postpartum haemorrhage
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12
Q

Name 5 perinatal complications shoulder dystocia

A
  • Brachial plexus injury
  • fractures
  • hypoxia ischaemic encephalopathy
  • long term neurological disability
  • death
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13
Q

Management shoulder dystocia (9)

A

HELPERR

First line

  • help: call for help
  • edge of bed + evaluate for episiotomy
  • legs: McRobert’s maneuvre (knees to chest )

Second line

  • pressure suprapubically + downward traction on foetal head to deliver ant arm
  • enter: rotational manoeuvres: posterior axilla sling traction, woods or Rubin’s
  • remove posterior arm.

(Consider repeating)

  • roll pt onto all fours (gaskin maneuvre )

3rd line

  • zavinelli (push head back) for c/s
  • clavicular #
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14
Q

Active phase labour average length?

A

PRIMI: 12 hours
Multi: 10 hours

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15
Q

Analgesia for labour

A

Pethidine 1 mg / kg (max 100 mg)
Or
Morphine 0,1 mg/kg (max 10mg) IM 4 hourly

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16
Q

Typical duration latent phase labour?

A

About 24 hours

17
Q

What must be noted on pv during labour? (5)

A
  • Dilatation
  • cervical length
  • membranes
  • kaput + moulding
  • position foetal head
18
Q

Partogram: 1 block = how many hours in latent and active phases?

A

Latent: 1 block = 2 hours
Active: 1 block = 1 hour

19
Q

How describe liquor on partogram? (4)

A

I/c/m/b

Intact: membranes not ruptured
Clear:
Meconium stained
Blood stained

20
Q

Define caput and how to describe on partogram

A

Swelling of infant’s scalp.
0,1 +,2+

21
Q

Define moulding and how to describe on partogram

A

Foetal skull bones moving closer/overlap to fit through pelvis. Try to separate sutures
O: sutures separate
1+ sutures opposed
2+ overlapped but reducible
3+ overlapped and not reducible

22
Q

Management partogram on action line?

A

4 ps

Power
Passage: CPD
Passenger: presentation, size…

Psyche: pain…

23
Q

Name 3 indications assisted delivery

A
  • Maternal: inefficient effort eg exhaustion, underlying condition precluding pushing eg cardiac
  • foetal: non-reassuring ctg
  • other: prolonged second stage labour
24
Q

Name 6 contraindications assisted delivery

A
  • Non vertex presentation
  • unengaged foetal head
  • unknown foetal head position
  • premature <34 weeks
  • known foetal coagulation disorder
  • known foetal demineralisation disorder
25
Q

Pre-op Checklists for assisted delivery? (4)

A
  • Maternal
  • foetal
  • uteroplacental
  • other
26
Q

Pre-op maternal checklist for assisted delivery? (7)

A
  • Informed consent
  • analgesia
  • lithotomy
  • empty bladder
  • adequate pelvis
  • consider episiotomy
  • for vacuum, uterine contractions and maternal effort must be present!
27
Q

Pre-op foetal checklist for assisted delivery? (5)

A
  • Vertex
  • foetal head must be engaged: 0/5 above brim
  • known foetal head position
  • document estimated foetal weight. Ideally 2500 - 4000g
  • assess foetal head attitude, kaput, moulding, asynclitism (oblique malpresentation)
28
Q

Pre-op uteroplacental checklist for assisted delivery? (3)

A
  • Fully dilated cervix
  • no placenta praevia
  • ruptured membranes
29
Q

Pre-op procedural/other checklist for assisted delivery? (5)

A
  • Alert anaesthesia, nursing, neonatology
  • experienced operator
  • monitor foetus continuously
  • be able to perform emergency Caesar
  • be prepared for shoulder dystocia
30
Q

How choose assisted delivery instrument?

A

Forceps: safer for foetus. Generally preferred
Vacuum: safer for mother ; need uterine contractions and maternal effort

31
Q

Describe vacuum assisted delivery ( 5)

A
  • Cup applied over flexion point, which is 3-4 cm in front of occiput in midline, indicated by sagittal suture
  • begin with suction at 0,7 - 0,8 kg/cc^2
  • Traction in direct line of vaginal canal perpendicular to head
  • no rocking motions. Should not last > 5 mins.
  • discontinue if cup slips off 3 times
32
Q

Describe forceps assisted delivery ( 3 )

A
  • Appropriate application so that forceps grasp sides of foetal head.
  • long axis of blades correspond to occipital - mental diameter. Tips of blades over cheeks.
  • blades equidistant from sagital suture, which bisects horizontal plane. posterior fontanelle is 1 finger breadth anterior to this plane.
  • Fenestrated blades should admit no more than 1 finger breadth between heel of fenestration and foetal head.
  • don’t grasp maternal tissue
  • abandon if difficulty applying, no descent with traction, not delivered in reasonable time, after 3 pulls
33
Q

Name 7 maternal complications assisted delivery

A
  • pain at delivery, perineal pain
  • lower genital tract lacerations/haematoma
  • urinary retention, incontinence
  • anal incompetence
  • pelvic organ prolapse
  • fistulae
  • Anaemia
34
Q

Name 8 foetal complications assisted delivery

A
  • Intracranial haemorrhage
  • bruises
  • abrasions, lacerations
  • facial nerve palsy
  • cephal haematoma
  • retinal haemorrhages
  • skull fracture
  • subgaleal haematoma

Gynaecology (40 decks)

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