Labour Flashcards
Induction of labour:
- Indications (5)
- Methods (3)
- Monitoring: bishops score: when taken, what’s in score
- Complications
Induction of labour:
- Indications (5): post term, maternal conditions (gest, eclamp, obst), iGUR, stillbirth, PROM
- Methods (3): dinoprostone prostaglandin ripens + cont, amniotomy + iv oxytocin, membrane sweep
- Monitoring: bishops score: when taken, what’s in score: dilatation, effacement, position, station of fetus, consistency
- mx
If >6 likely to go into natural labour so amniotomy + iv oxytocin
If < or equal to 6 unlikely to start without induction - need vag prostag or oral misoprostolol (prostg e1) - Complications : uterine hyperstim (interupts blood flow to baby causing hypoxemia + uterine rupture). Need to remove infusion or pessary + consider tocolysis - more than 5 in 10 mins or 1 cont every 2 mins
Perineal tears:
- Classification of tears: first, second, third, fourth degree
- Risk factors
- Prevention
- Complications: short, long term
Perineal tears:
- Classification of tears: first, second, third, fourth degree
1. through minora - no repair
2. through perineal muscles - suture
3. through anal sphincter - theatre repair
4. through rectal mucosa - Risk factors : first baby, macrosomia, forceps, shoulder dystocia
- Prevention: episiotomy, perineal massage 34 weeks on
- Complications: short, long term : infection, pain, dehiscence, incont, dysparinea, mental health
Labour:
- Definition
- Signs
- Monitoring
- Stages of labour
Labour:
- Definition
- Signs: regular painful contractions, shedding of mucus plug, rupture mems, shortening/dilating cervix
- Monitoring: fhr every 15 mins/ctg, mat pulse every 60 mins, mat bp/temp every 4 hours, ve every 4 hours
- Stages of labour
1. regular contractions until cervix fully dilated - latent: 3cm, active: after 3. Should progress 1cm every hour
2. delivery of baby. head enters pelvis in occipito lat position and should turn occipito ant position- if not problems with passage, passenger, power
3. placenta
Failure to progress:
- Causes
- Management
Fetal distress:
- Signs
- Causes
- Indications for continuous CTG
Abnormal fetal lie:
- Definition of lie, presentation, position
- types breech
- Risk factors
- Complications of breech
- Management
- Containd
Abnormal fetal lie:
- Definition of lie, presentation, position
- types breech: frank (hips flexed, knees fully extended), footling (one or both feet come first)
- Risk factors : multiple, prematurity, fibroids, praevia, poly/oligohyd, fetal abnormality
- Complications of breech : head trapped, hip dysplasia, brain bleed, prom, cord prolapse
- Management : external cephalic variation at 36 weeks null, 37 weeks multi. If not c sections
- Cont to ext cephalic: ruptured mems, <7 days since a haemorrhage, multiple preg, major uterine abnormal, not in active labour >3cm, abnormal ctg
VBAC:
- Adv + disadv of VBAC and elective c section
- Contraindications to VBAC: absolute, relative
- Benefits of c section
- Complications of c section
VBAC:
- Adv + disadv of VBAC and elective c section
Adv c section: pain free, less risk scar rupture, less risk tear/injury
Dis c section: more c sections you have less likely vag birth for next, dec recovery, dec RDS - Contraindications to VBAC: absolute, relative
Absolute: classic scar, previous rupture, cont to vag birth
Relative: >2 c sections
Instrumental delivery:
- Indications (3)
- Requirements needed before
- Types
- Complications
Instrumental delivery:
- Indications (3): fetal distress or maternal distress in second stage, failure to progress in second stage
- Requirements needed before: fully dilated + engaged, no membranes, cephalic
- Types: foreceps, ventouse x 3 only
- Complications to mum: tears, pph, incontinence. To baby: cephalohaematoma, facial nerve palsy
Shoulder dystocia:
- Definition
- Risk factors: pre-labour, labour
- Management
- Complications
Shoulder dystocia:
- Definition : delivery of head but shoulders get stuck behind pubic symphisis
- Risk factors: pre-labour, labour: previous, macrosomia, bmi >30, diab, induction, prolonged labour, instrument
- Management: get help, mcroberts (flexion + abduction hips, woods screw, zavanelli (push baby back in for c section)
- Complications: hie, brachial plexus inj, tear, pph
PPH:
- Definition
- Causes
- Risk factors
- Complications
- Management
PPH:
- Definition : prim is >500ml in 24 hours, 2nd is up to 12 weeks (retained tissue/endometritis)
- Causes : trauma, tissue retained, tone, thrombin
- Risk factors : macrosomia, obese, multiple preg, previous, pre-ec
- Complications : hypovol shock, anaemia, aki, dic, sheehans
- Management :
1. senior, lie flat
2. 2 large bore iv cannulas - fbc, g&s, clotting
3. iv fluids, catheter
4. uterine fundus massage, catheter to empty bladder, syntocinon oxytocin IV, then ergometrin (not if htn), then syntocinon again, then IM carboprost (not if asthma) then misoprostol sublingual
5. surgery intrauterine balloon tamponade
Intrauterine growth restriction:
- Definition
- Causes : symmetrical vs un
- Risk factors: mum, fetus, uterus
- Investigations
- Management
- Complications
symm: genetic abnorn, infection
assymp: placental insuff
Premature labour without rupture membranes:
- Management
Premature labour without rupture membranes:
- Management : tocolysis + nifedipine decreases contraction if 24-34 weeks for up to 48 hours in order to give steroids
Preterm prelabour rupture of membranes PPROM:
- ix
- risk f
- complications
- mx
Preterm prelabour rupture of membranes PPROM:
- Investigations: sterile speculum ex (pooling of amn fluid in post vaginal fornix), if not observed IGFBP1, PAMG1
- Risk factors : smoking, previous, infection, invasive procedure, multiple preg
- Complications: NRDS, infection, chorioamniotitis
- Management: admit, monitor reg for chorioamn signs, oral erythromycin 10 days or until in labour, dexameth if <35 weeks, if >34 weeks consider delivery, mg sulfate if 24-29 weeks
24-33 weeks, 34-36 weeks
Group B strep colonisation:
- Definition
- Risk factors
- Symptoms
- Management
Group B strep colonisation:
- Definition
- Risk factors: previous, prolonged rupture membranes, fever during labour, + GBS, prem
- Symptoms : fever, in baby sepsis/pneumonia / meningitis
- Management :
Offer IV benzylpenicillin (vanc if allergy) during labour if + gbs, prev, preterm labour, pyrexia. Then keep baby in + monitor
Previous should be offered abx OR late preg testing - swabs at 35-37 weeks
Prematurity:
- Definition + classification
- Causes
- Early complications
- Late complications
Prematurity:
- Definition + classification: Before 37 weeks
- Causes : planned, pprom, infection, eclampsia, placental abruption, idiopathic
- Early complications: inc risk infection, hypothermia, hypoglycemia, NRDS, intraventricular haemorrhage, neonatal jaundice, retinopathy of prematurity if <32 weeks, NEC, feeding problem
- Late complications : chronic lung disease of prematurity, learning disabilities, hearing/visual impairment, cerebral palsy
Amniotic fluid embolism:
- definition
- symptoms
- mx
Amniotic fluid embolism:
- definition: when fetal cells/amn fluid enters mums blood stream stimulating a reaction. Can happen during induction
- symptoms: chills, shivering, sweating, anxiety, coughing, cyanosis, hypotension, bronchoaspam, tachyc, arrhythmia, mi
- mx: critical care for supportive
Rubella
- when at risk
- symptoms congen rubella syndrome
- ix
- mx
Rubella
- when at risk: in first 10 weeks
- symptoms congen rubella syndrome: sensorineural deafness, congen cataracts, PDA, growth retardation, hepatosplenomegaly, cerebral palsy
- ix: igm ab in mum
- mx: local health protection unit, mmr post natally or pre
Caesarean section
- Types
- Indications
- Categories
- Risks
Caesarean section
- Types: lower segment c section most common, classic (longit incision in upper segment of uterus)
- Indications: fetal distress, malpresentation, abruption causing distress, HELP/pre-ec, mum infection HIV/active herpes, praevia 3/4, IUGR, post maturity
- Categories
1. immediate threat to life - within 30 mins
2. mat or fetal compromise - within 75 mins
3. need delivery but both stable
4. elective
- Risks: emergency hysterectomy, vte, bladder/ureteric injury, haemorrhage, infection, fetal laceration
Cord prolapse
- definition
- risk factors
- mx
Cord prolapse
- definition: umbilical cord in the presenting part of the fetus which can lead to compression hence fetal hypoxia
- risk factors: prem, multip, polyhyd, twins, abnormal presentation, amniotomy
- mx: push head back. If out of vagina minimal handling + moist + warm. All 4s until c section. Fill bladder
