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Year 5-Obstretics > Labour > Flashcards

Labour Flashcards

1
Q

Labour defn?

A

painful uterine contractions accompany dilatation and effacement of cervix

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2
Q

how many stages does labour have?

A

3

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3
Q

First stage labour?

A

initiation to full cervix dilatation 10cm

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4
Q

second stage of labour

A

cervical dilatation to delivery of fetus

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5
Q

third stage of Labour?

A

delivery of placenta

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6
Q

what factors determine labour?

A

3 factors

Power - degree of force pushing fetus
passenger- fetus head diameter
passage - dimension of pelvis and resistance of soft tissue

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7
Q

Uterine contractions

A

45-60seconds every 2-4 minutes
pulling cervix up (effacement)

= dilatation

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8
Q

effacement?

A

thinning and shortening of cervix

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9
Q

The passage
bony pelvis
Pelvis inlet diameter

A

around 13 cm transverse
anteroposterior is 11cm

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10
Q

what is level of descent?

A

the landmark that is used is the ischial spines

this is measuring descent of head

level of descent of the head is known as the station in relation to ischial spines

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11
Q

what is station 0?

A

station 0 means head of fetus is at the ishcial spines

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12
Q

station -2 means?

A

head is 2cm above ischial spine level

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13
Q

anterior fontanelle

posterior?

A

bregma
occiput

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14
Q

what is vertex presentation?

A

maximal flexion of fetus head, head bowed

presenting diameter would be 9.5cm anterior fontanelle to below occiput

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15
Q

why must the fetus head rotate during delivery?

A

if sagital suture is transverse at point of entering pelvic inlet - fits best

but at outlet the sagittal suture must be vertical for head to fit to pass out

so rotation by 90degrees is needed to get this

delivering occiput-anterior

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16
Q

can you deliver occiput-posterior

A

yes but more complicated only 5%

you can’t deliver occipto transverse

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17
Q

oxytocin produced where?

A

posterior pituitary gland
aids stimulation of contractions

prostaglandins stimulate this and help reduce cervical resistance

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18
Q

First stage of labour is split into?

A

this stage involves rupture of membrane

latent stage: dilates to 4cm
active phase: 1cm/hr in nulliparous, 2cm/hr in multiparous (should not last longer than 16 hours?)

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19
Q

passive second stage

A

Dilatation of cervix to delivery of fetus

lasts till head reaches pelvic floor - rotation and flexion are done by now

can last a few minutes

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20
Q

active second stage

A

mother is pushing
pressure of head
40-20 mins

> 1 hour means spontanous labour won’t occur

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21
Q

placental delivery

A

lasts upto 15 mins
upto 500ml of blood loss is normal

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22
Q

10 steps of labour

A
  1. Descent
  2. Engagement – identified by abdominal palpation, foetal head is 3/5th palpable or less
  3. Neck flexion
  4. Internal rotation
  5. Crowning
  6. Extension of the presenting part
  7. Restitution
  8. External rotation
  9. Lateral flexion
  10. Delivery of the shoulders and foetal body
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23
Q

risk factors for foetal compromise?

maternal factors

A

previous C section
hypertension
PROM
vaginal blood loss
maternal sepsis/ chorioamniontis
GDM

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24
Q

hyperactive uterine activity
causes
imapct

A

fetal distress as placental blood flow is impaired

associated with abruption
prostaglandin use
too much oxytocin

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25
Q

tocolytics

A

suppress uterine contractions

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26
Q

most common tocolytics

A

magnesium sulfate
CCB - nifedipine

NSAIDS: indomethacin

b2 agonists : terbutaline / salbutamol (IV or subcut)

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27
Q

effects of tocolytics
CCB

A

block calcium channels
inhibits calcium ions
reducing contractility - smooth muscle relaxation

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28
Q

effects of magnesium sulfate

A

neuroprotective - useful in preterm brain

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29
Q

effect of nsaids on prostaglandins

A

inhibit COX enzyme (this typically stimulates prostaglandin production)

reduced prostagland levels

relaxation of uterine muscles

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30
Q

fetal distress defn

A

hypoxia that might result in fetal death / damage if not reversed or delivered

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31
Q

how is fetal distress measured?

A

<pH 7.2

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32
Q

fetal distress steps

A

intermittent auscultation of fetal heart

continoud CTG

Fetal blood sampling

delivery

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33
Q

when is Continous CTG indicated

fetal factors

A

fetal growth restriction
anhydramnios or polyhydramnios
advanced gestational age

small for gestational age
non cephalic presentation

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34
Q

what is polyhydramnios

what is a normal amount?

A

increased volume of amniotic fluid
comprises of fetal urine output

500ml

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35
Q

causes of polyhydramnios?

A

anything that prevents fetus from swallowing
(obstruction of oesophagus, neuro problems, atresia etc)

increased lung secretions like in CF

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36
Q

types of pain relief
medical

A

entonox (NO)
opiates
epidural

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37
Q

why is supine position avoided in pregnant women?

A

Gravid (heavy) uterus compresses main blood vessels > CO reduced> hypotension = fetal distress

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38
Q

what is aortacaval compression?

A

supine lay in a gravid women causing reduced CO and hypotension leading to fetal distress

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39
Q

fever of 38 degrees in labour?

A

risk of neonatal illness (? chorioamnionitis)
>37.5 bad

cultures of vaginal, urine and blood taken

paracetamol given IV abx
cTG monitoring

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40
Q

Bishop score of 8?

A

Favourable cervix likely to progress spontanously

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41
Q

Bishop score of <6?

A

induction needed
offer vaginal prostaglandin

42
Q

bishop score of 7?

A

ARM followed by IV oxytocin

43
Q

prostaglandin E role in IoL

A

gel/slow release into psoterior vaginal fornix

activates prostaglandin e2
soften cervix and dilates blood vessel

44
Q

amniotomy?

A

amnihook (instrument used) ruptures waters then you give oxytocin within 2 hours

45
Q

natural inductions?

A

membrane sweep
releases physiological prostaglandins
offered at 40 weeks for nulliparous
41 multiparous

46
Q

indications for IoL
Fetal causes:

A

prolonged pregnancy
IUGR
anterpartum haemorrhage
prelabour term rupture of membranes

47
Q

indications for IoL
materno-fetal causes

A

pre-eclampsia
maternal diabetes
previous caesarian
maternal request
breech
fetal macrosomia

48
Q

contraindications for IoL

A

acute fetal compromsie CTG/lie

placenta praevia!!!

49
Q

prostaglandin e2 gel?

A

Prostin®

50
Q

prostaglandin e2 pessary?

A

propess

51
Q

what is cervical ripening balloon?

A

catheter inserted into cervix which can mechanical induce labour

safe for baby
less risk of uterine hyperstimulation

52
Q

define risk for CTG
maternal factors?

A

previous c-section
pre-eclampsia
antepartum haemorrhage
post term pregnancy
rolonged rupture of membrane >24 hours
significant maternal disease

53
Q

what is delay in first stage?

A

<1cm per 2 hours

54
Q

how to manage delay?

A

ARM review in 2 hours
oxytocin

55
Q

types of delay?

A

primary dysfunctional labour
secondary arrest of labour (progressed well then stopped)

prolonged latent phase
cervical dystocia

56
Q

what is delay in second stage?
Nulliparous women

A

from active second (cervix dilated to 10cm)
3 hours with epidural
2 without epidural

57
Q

what is crowning?

A

when head no longer recededs between contractions

58
Q

immediate care of neonate?

A
59
Q

when do you need to start continuous CTG monitoring?
contractions?

A

contractions last longer than 2 mins
5 or more contractions in 10 minutes

60
Q

when do you need to start continuous CTG monitoring?
infection risk factors

A

maternal pyrexia
chorioamnionitis
sepsis

61
Q

when do you need to start continuous CTG monitoring?
relating to maternal obs

A

pulse over 120 bpm on 2 occasions more than 30 mins apart

severe hypertension >160/110

hypertension 140/90

protein 2+ and raised bp>140/90

fresh vaginal bleed
abnormal pain
blood stained liqour

62
Q

when do you need to start continuous CTG monitoring?
other

A

insertion of regional anaesthetic
use of oxytocin

63
Q

immediate care of newborn
when is apgar score calculated?
what is a normal score?

A

1 minute
5 minute

> 7 is good

64
Q

what apgar score is most worrying?

A

0-3

65
Q

when is vit K given?
why?

A

immediately

to prevent vit K dependent bleeding

66
Q

apgar score

A

appearnace
pulse
grimace
activity
respiration

67
Q

APGAR heart rate?
what scores 2

A

> 100 beats/min scores 2

68
Q

APGAR score heart rate what scores 1?

A

<100 bpm

69
Q

SCore 0 for APGAR

A

HR: absent
RR: absent
muscle tone: flaccid
reflex: none
colour: plae/blue

70
Q

apgar score what scores 1?

A

<100bpm HR
gasp/irregular : Respiratory effort
flexion of limbs : muscle tone
grimace : reflex irritability
body pink , extremities blue : colour

71
Q

what scores 2 on apgar?

A

> 100beats per minute : HR
regular strong cry : respiratory effort
well flexed/ active : muscle tone
cry/ cough : reflex irritability
pink :colour

72
Q

causes of PPH?

A

tone - atony most common
tissue - retained products
trauma - (laceration)
thrombin - coagulopathy

73
Q

how to manage meconium aspiration?
no history of GBS?

A

observation recommended

74
Q

41 week old delivery has asymmetrical patchy opacities on chest x-ray
mother had a temp of 38 at delivery
what is this?
how to manage?

what else can be offered ?

A

meconium aspiration
sign of infection so IV ampicillin and gentamicin

CPAP and/or oxygen therapy
boluses of surfactant
inotropes

75
Q

what is prelabour term rupture of membrane also known as?

A

premature rupture of membrane
so baby at term 37 weeks but waters break before uterine activity has started

76
Q

what two signs in PROM indicate immediate IoL?

A

presence of meconium
positive group b strep results (from vaginal swab?)

77
Q

PROM management?

A

admit
speculum
(vaginal swab sent for infection)
4 hr temp
24hr foetal monitoring

78
Q

how long can you give expectnat management for PROM (from when membranes rupture)?

A

24 hours 60& will deliver sponatanously

79
Q

what is preterm prelabour rupture of membrane?

A

before 37 weeks rupture of membrane without uterine activity

here you want to prevent and protect foetus because it is not fully developed
particularly before 34 weeks

80
Q

diagnostic Investigation for PPROM / PROM?

A

speculum (amniotic fluid pooling is diagnostic)

look at os (open/closed)
pooling

then test IGFBP-1 / PAMG-1

81
Q

if >30 weeks contractions are present and Os is closed whatd o you do?

why?

what does this tell you?

A

TVUSS for cervical length
<15mm likely to preterm labour
>15mm unlinkely to be preterm labour

82
Q

can you offer tocolysis for P-PROM?

A

no due to increased risk of infection

83
Q

Mx of P-PROM

A

admit (at least until 28 weeks then depends but seen 2/3x weekly)
sterile speculum exam

offer Abx: erythromycin (2nd line penicillin)

offer maternal corticosteroids (IM betametasone 24mg)

offer IV magnesium sulfate (if birth expected in 24 hours)

84
Q

when in p-prom do you immediately offer IoL?

A

> 34 weeks
group b strep signs

85
Q

what is abx given in pprom?

A

1st line erythromycin QDS 250mg
2nd line penicillin

86
Q

dose of magnesium sulfate and why is it given in PPROM?

A

IV

neuroprotection of foetus especially if <30 weeks
effects after 30 weeks are unclear

87
Q

corticosteroid in PPROM?

A

IM betametasone 24mg / in 2 doses 12 hours apart

assists with lung maturation (if less than 34 weeks

88
Q

risk factor for pprom /prom?

A

smoking
sti
previous hx
multiple pregnancy

89
Q

PROM
risk of infection to neonate?
how many women will go into labour by 24 hours

complication?

A

1% compared to 0.5% of intact

60%

attempt to induce at 24 hours

risk of ascending infection

90
Q

complication of pprom?

A

maternal: sepsis, cord abruption

foetal: chorioamnionitis, cord prolapse, pulmonary hypoplasia, death

91
Q

preterm labour can be classified into?

A

PTL : 32-37
very PTL: 28-32 weeks
Extremely PTL: <28

92
Q

causes of preterm labour?

A

infection
overdistention of abdomen?
polyhydramnios
multiple pregnancy

93
Q

predicting preterm labour
how many factors?

how many do you need to be offered prophylaxis?

A

previous Hx of spontanous birth <34 weeks

mid trimester loss (>16 weeks )

cervical length <25mm on USS

if 2 then defo offer
if 1 then sugggest

94
Q

prevention of pre term labour
mx?

A

vaginal progesterone started 16-24 and continue till 34 weeks

cervical cerclage

95
Q

contraindications to rescue cervical cerclage?

A

bleeding
infection
uterine
contractions

96
Q

mx of preterm labour?

A

admit
offer maternal steroids
offer tocolytics
Iv magnesium sulphate
aim for delivery 37 weeks

97
Q

tocolytic use in preterm labour?

A

1st line nifedipine (CCB)
2nd line atosiban oxytocin receptor antagonist

98
Q

dose of magnesium sulphate?

A

4g over 5-15 mins IV infusion of 1g/hour

continue till birth or 24 hours

99
Q

antidote to mgso4

A

10ml 10% calcium gluconate over 10mins (and stop magnesium
sulphate infusion

100
Q

complications of pre term birth?

A

RDS > retinopathy of prematurity

necrotising enterocolistis
intraventricular haemorrhage
periventricular leukomalacia

101
Q
A

Year 5-Obstretics (15 decks)

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