Labour Flashcards
1
Q
Induction of labour:
- Indications (5)
- Methods (3)
- Monitoring: bishops score: when taken, what’s in score
- Complications
A
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
2
Q
Perineal tears:
- Classification of tears: first, second, third, fourth degree
- Risk factors
- Prevention
- Complications: short, long term
A
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
3
Q
Labour:
- Definition
- Signs
- Monitoring
- Stages of labour
A
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
4
Q
Failure to progress:
- Causes
- Management
A
5
Q
Fetal distress:
- Signs
- Causes
- Indications for continuous CTG
A
6
Q
Abnormal fetal lie:
- Definition of lie, presentation, position
- types breech
- Risk factors
- Complications of breech
- Management
- Containd
A
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
7
Q
VBAC:
- Adv + disadv of VBAC and elective c section
- Contraindications to VBAC: absolute, relative
- Benefits of c section
- Complications of c section
A
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
8
Q
Instrumental delivery:
- Indications (3)
- Requirements needed before
- Types
- Complications
A
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
9
Q
Shoulder dystocia:
- Definition
- Risk factors: pre-labour, labour
- Management
- Complications
A
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
10
Q
PPH:
- Definition
- Causes
- Risk factors
- Complications
- Management
A
PPH:
- Definition : prim is >500ml in 24 hours, 2nd is up to 12 weeks
- 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 carboprost (not if asthma) then misoprostol
5. surgery intrauterine balloon tamponade
11
Q
Intrauterine growth restriction:
- Definition
- Causes : symmetrical vs un
- Risk factors: mum, fetus, uterus
- Investigations
- Management
- Complications
A
symm: genetic abnorn, infection
assymp: placental insuff
12
Q
Premature labour without rupture membranes:
- Management
A
Premature labour without rupture membranes:
- Management : tocolysis + nifedipine decreases contraction if 24-34 weeks for up to 48 hours in order to give steroids
13
Q
Preterm prelabour rupture of membranes PPROM:
- ix
- risk f
- complications
- mx
A
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
14
Q
Group B strep colonisation:
- Definition
- Risk factors
- Symptoms
- Management
A
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
15
Q
Prematurity:
- Definition + classification
- Causes
- Early complications
- Late complications
A
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
