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Phase 3a Obstetrics + sexual health > Labour > Flashcards

Labour Flashcards

1
Q

What can happen before labour begins which makes you think a female is in a labour?

A

Braxton Hicks

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1
Q

How many stages of labour are there?
what are they called?

A

3 stages
stage 1 - latent and active
stage 2 - baby delivery
stage 3 - placental delivery

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2
Q

What are Braxton hicks?

A

vague cramps in 3/3
Mild, Irregular, uncomfortable and painless tightening of uterine wall

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3
Q

What happens before labour begins?

A

Bloody show, mucus plug
Just before - spontaneous rupture of membranes (ROM),

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4
Q

What is happening to the cervix in stage 1?

A

it is shortening and widening

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5
Q

How long does stage 1 latent phase last for?
length for Primi vs multi
Dilation?
diameter and contractions?

A

20 hours Primi (1)
14 hours multi
Dilation <30%
0-4cm diameter
contractions 1-3 mins

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6
Q

How long does stage 1 active phase last for?
length for Primi vs multi
Dilation?
diameter and contractions?

A

6 hours primi
5 hours multi
dilation 30-100%
5-10cm diameter
contractions 60s every 1-2 mins

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7
Q

What is the dilation rate for primi/multi?

A

1.2cm primi
1.5cm multi

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8
Q

What is stage 2 of labour?
Length for Primi/multi?

A

Baby comes out
2 hours Primi
1 hour multi

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9
Q

What are the 3 Ps in stage 2 labour that affects labour time?

A

Power (tone)
Passage (pelvic inlet dimensions S2-S4)
Passenger (cephalopelvic proportion)

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10
Q

What are the movements of the foetus out of the mum?

A

Engage
Decent
Flexion
Internal rotation
extension
External rotation
Restitution
Expulsion

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11
Q

What is stage 3 of labour?
Time?

A

deliver the placenta + monitor Postpartum haemorrhage
30 mins

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12
Q

What do we check in the placenta?

A

check placental remnants
2 umbilical arteries and 1 umbilical vein

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13
Q

What is a portogram used for?

A

Labour progression
Parameters to measure maternal + fetal health during labour
can guide the need to add/change methods
eg. cat 1 c section if distressed

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14
Q

What is the bishop score used for?

A

to assess cervical ripeness
How likely a woman is to go into labour

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15
Q

What is the acronym for the bishop score?

A

CDEFP

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16
Q

What does CDEFP mean?

A

Consistency
Dilation
Effacement
Fetal station
Position

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17
Q

What are the different scores for the bishop criteria?

A

<5
5-7
>8

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18
Q

what do these mean?
<5
5-7
>8

A

<5 - Unripe therefore unlikely to spontaneously induce - need to induce labour

5-7 - intermediate

> 8 - Ripe, likely to spontaneously induce

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19
Q

What are some indications to induce?

A

Prolonged labour
Preterm premature rupture of membranes (PPROM)
Maternal issues = Gestational DM, Pre eclampsia, obs, Cholestasis

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20
Q

What bishop scores determine the different ways of inducing labour?

A

6 or less
more than 6

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21
Q

How is labour induced in a bishop score 6 or less?

A

Membrane sweep
Vaginal Prostaglandin (gel or pessary)
PO Misoprostol

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22
Q

What do prostaglandins do?

What is a common prostaglandin gel that’s used and what type of prostaglandin is it?

What type of pros is misoprostol?

A

Promote cervical ripening

Dinoprostone gel (Prostaglandin E2)

Prostaglandin E1

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23
Q

How is labour induced in a bishop score of above 6?

A

Amniotomy (ARM)
IV Oxytocin

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24
Q

What is an example of an oxytocin that is used and what does it do?

A

Syntocinon
Stimulates contractions

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25
Q

What is induction Contraindicated in?

A

Vasa previa and cord prolapse

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26
Q

What is a complication of inducing labour and what can this cause?

A

Uterine hyperstimulation
>6 contractions in 10 mins
Risk of foetal ischemia and uterine rupture

27
Q

What is conservative pain relief for labour?

A

Perianal + fundal massage
TENS (transcutaneous electrical nerve stimulation)

28
Q

what are some medications given in labour for pain relief?

A

Entonox
Pethidine
Morphine

29
Q

What are the side effects of entonox?

A

N+V

30
Q

What are the foetal and maternal side effects of pethidine/morphine?

A

foetal = Resp depression, diminished breast feeding/seeking behaviour

maternal = Euphoria/dysphoria, N+V, longer labour

31
Q

How effective is the epidural?

A

85-90% effective

32
Q

Epidural Contraindications?

A

Low platelets (Risk of bleeding)
On DOAC/Aspirin
High ICP
bleeding disorders
allergy

33
Q

Side effects of an epidural?

A

Urine retention
Hypotension (low BP)
Hypoanalgese
Headache (1/100 post epidural)

34
Q

When can an epidural be denied?

A

Foetal distress
Antepartum haemorrhage

35
Q

What are 2 other things that can be given in labour?

A

IV Benzylpenicillin
RhoGAM

36
Q

Why would benzylpenicillin + RhoGAM be given?

A

If there is Group B strep bacteria in urine (GBS) or UTI at any time in pregnancy

If Rhesus negative

37
Q

What can be given instead of benzylpenicillin if they’re allergic?

A

Clindamycin

38
Q

C section is what % of births?

A

25%

39
Q

What are the 3 types of incisions?

A

Classical (midline)
Joel Cohen Incision
Pfannenstiel

40
Q

classical (midline) incision
is it done?
Increased risk of?

A

not done
Increased risk of uterine rupture with vaginal birth after caesarian
CI to VBAC

41
Q

What is a Joel Cohen incision?

A

Incision through 7 layers

42
Q

What are the 7 layers that are incised through?

A

Skin
Scarpa fascia
camper fascia
Rectus sheath
Rectus abdominis
Peritoneum
Uterus

43
Q

what is a CI to vaginal birth?

A

2 or more C Section

44
Q

Complications of C section?

A

VBAC rupture (1/200)
Postpartum haemorrhage
Endometriosis
TTON

45
Q

What are some indications for a c section?

A

Placenta previa
Vasa previa
Failure to progress
Active genital herpes
Cord prolapse
Fetomaternal distress

46
Q

CAT:
1
2
3
4
What do these mean?

A

Cat 1 - emergency <30 mins
Cat 2 - <75 mins
Cat 3 - needed not immediate
Cat 4 - elective

47
Q

What is a CTG?
what does it stand for?
What is it used for?

A

Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother’s abdomen. CTG is widely used in pregnancy as a method of assessing fetal well‐being, predominantly in pregnancies with increased risk of complications.

48
Q

What is the acronym for CTG findings interpretation?

A

DR C BRAVADO

49
Q

what does DR C BRAVADO stand for?

A

DR = Define risk
C = contractions
BRA = Baseline heart rate
V = Variability
A = accelerations
D = decelerations
O = overall

50
Q

What does
Define Risk
Contractions mean?

A

DR - High or low risk?
C - No of contractions in 10 mins, duration and intensity
3-5 every 10 mins

51
Q

What does
Baseline Heart rate
Variability mean?

A

BRA - Check 10 mins, 110-160 bpm
V - variation of foetal HR from 1 beat to the next - 5-25 bpm normal

52
Q

What does
Accelerations
Decelerations
Overall mean?

A

Abrupt increase or decrease in fetal HR of 15 bpm longer than 15 secs
Overall good or bad

53
Q

When can you only do a CTG?

A

28 WEEKS ONWARDS

54
Q

Low risk (good) CTGs have?
Contractions?
HR?
Variability?
A or D

A

regular contractions
HR 110-160
Accelerations present
Early decels

55
Q

High risk (bad) CTGs have?
HR?
Variability?
A or D

A

Bradycardia/tachy
Variability <5
No acceleration
late (or variable) decels

56
Q

What does it mean when <40 variability?

A

sleeping foetus

57
Q

What would you consider if CTG is high risk/bad?
what would be seen on that?

A

Fetal scalp sample
low pH = indicates HYPOXIA

58
Q

What are the 2 types of instrumental delivery methods?

A

Ventouse (vacuum cup) - suction cup
Forceps

59
Q

What are the 2 things the ventouse can cause?

A

cephalohematoma (blood under scalp) - bad
Caput Succedaneum (swelling of scalp) - better

60
Q

When do you offer instrumental aid in birth?

A

Fetal distress
Premature delivery
HTN/Comorbidities

61
Q

What is cephalohematoma?
when does it resolve?

A

Subperiosteal bleed confined to suture lines
resolves in 3 months or less

62
Q

What can happen that is even worse than a cephalohematoma?

A

Subgaleal (extra cranial bleed of emissary veins, crosses suture lines, fetal distress and shock)

63
Q

What is caput succedaneum?

A

SC oedema resolves in days
not confused

64
Q

What can forceps delivery cause?

A

can cause CN7 palsy

Phase 3a Obstetrics + sexual health (15 decks)

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