Labour Flashcards
post partum haemorrhage
initial steps
why palpate the ____
A-E approach
warmed crystalloid infusion
palpate uterine fundus
catheterise
to stimulate contractions
prevent bladder distention
monitor output
medical mx of PPH
IV oxytocin (IV injection)
IV infusion
ergometrine (slow IV / IM)
carboprost IM
misoprostol sublingual
Sx mx of PPH
ligation of _____ artery / ___ ___ arteries
life saving?
intrauterine balloon tamponade
B-lynch suture
ligation of uterine
internal iliac arteries
hysterectomy
cause of 2 PPH
24 hours - 6 weeks
retained placental tissue / endometritis
ABC approach
2 peripheral cannualae, 14 gauge
lie women flat
bloods (G+S)
warmed crystalloid infusion
oxytocin given how in PPH
5U of IV syntocinon followed by 0.5mg og ergometrine
Bishop score >6
41 week gestation
membrane sweep performed
do you do
1)Amniotomy and an intravenous oxytocin infusion or
2) Vaginal prostaglandins
Amniotomy and an oxytocin infusion is correct.
Also known as artificial rupture of membranes, this is a procedure where the midwife or obstetrician intentionally breaks the amniotic sac to stimulate labour contractions. This is then followed by an oxytocin infusion which is a hormone used to induce contractions. NICE recommends that this combination should be used in cases where the Bishop score is greater than 6 as in this patient. The Bishop score is a system used to assess the readiness of the cervix for labour and to predict the likelihood of successful induction of labour. Amniotomy and oxytocin infusions are interventions that work when the cervix is favourable (i.e. score over 6). There is little point inducing contractions if the cervix is not ready
Cervical ripening balloon
Foley catheter balloon, is a medical device used to help ripen or soften the cervix
Makes the cervix more favourable for labour by promoting dilation and effacement
golden rule for foetal bradycardia
rul e of 3s
3 minutes – call for help
6 minutes – move to theatre
9 minutes – prepare for delivery
12 minutes – deliver the baby (by 15 minutes)
SCREENING
8 - Advise + Bloods (The setup)
10 - Scans to confirm dates
11 - Looks like Chromosomes = Down’s syndrome scan via NUCHAL
16 - The results are back girls! No down’s syndrome, but check Hb < 11
18 - This is when we all leave home to be an Anomaly in our family. Hence, Anomaly Scan.
28 - 1st Dose of Anti-D, this is logical because the fetal immune system develops at 28 weeks. + Check Hb <10.5
34 - 2nd Dose of Anti-D (8 weeks later, same digit as 28 weeks)
38 - RC
41 - RC
FORCEPS - labour instrumental delivery requirements
fully dilated cervix
OA; keillands forceps
ruptured membranes
cephalic presentation
engaged presenting part - head below ischial spines
pain
sphincter - empty
breech vaginal delivery - instrumental delivery?
piper forceps
PPROM confirming
speculum
test fluid for placental alpha microglobulin 1 prtein - PAMG-1 or insulin like growth factor binding protein 1
transvaginal USS
when does gestational htn start?
after 2o weeks
normally bp falls in first trimester
until 20-24 weeks
occiputposterior presentation
posterior fontanelle is found in the posterior quadrant of pelvis
labour is usually longer
