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Y4 Obs & Gyn > Labour > Flashcards

Labour Flashcards

1
Q

How would you define the process of labour?

A

progressive effacement and dilatation of the cervix in the presence of regular uterine contractions

*which leads to the expulsion of the foetus and placenta known as ‘delivery’

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2
Q

What are some signs of labour?

A

regular and painful uterine contractions
a show (shedding of mucous plug)
rupture of the membranes (not always)
shortening and dilation of the cervix

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3
Q

what is stage one of labour?

A

between regular contractions (3-4x every 10 min) and cervix being 10cm dilated

- shortened if parous
- 1cm an hour normally
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4
Q

what is the 2nd stage of labour?

A

fully dilated to baby coming out

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5
Q

what is the 3rd stage of labour?

A

baby coming out to placenta out

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6
Q

what affects labour?
*3 prone

A
  • the passage: bony pelvis, soft tissue
  • powers: contractions, occur every 3-4 mins in early and 2-3 mins in advanced
  • passenger: lie of foetus, presentation, position
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7
Q

what is a ‘lie’ in terms of the passenger?

A

relationship of foetal long axis of baby to that of mother

Up-and-down (with the baby’s spine parallel to mother’s spine, called longitudinal) is normal

lie is sideways (transverse)

at an angle (oblique
(long, oblique, transverse)

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8
Q

what is the ‘presentation’ in relation to the foetus?

A

part of foetus lowermost in uterus
(cephalic, vertex, brow, face, breech, shoulder)

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9
Q

what is the ‘position’ regarding the foetus?

A

position - relation of foetal denominator (the name given to part of the presentation which is used to determine the position of the foetus) to maternal pelvis

occipitoanterior
occipitotransverse
occipitoposterior

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10
Q

what does it mean when the baby is breeched?

A

Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position

*could be frank, complete or footling

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11
Q

why are breeched deliveries complicated?

A
  • trapped after-coming head
  • cord prolapse
  • intracranial haemorrhage → rapid compression decompression as head not squeezed during descent, shouldn’t pull on baby due to reflexes
  • internal injuries
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12
Q

how do you monitor the mother in the first stage of labour?

A
  • vaginal exam every 4h, assess dilation, head position
  • maternal urine every 4h for ketones and proteins
  • maternal BP+ temp every 30 mins
  • contractions every 15 mins for strength and duration
  • foetal HR every 15 min
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13
Q

what are the steps of labour?

A
  • engagement where baby fixed in pelvis
  • flexion where neck to chest
  • descent through pelvis in line with med cavity into occipito-transverse position
  • internal rotation with contractions
  • extension of neck under pubis symphysis and head comes into view
  • external rotation where shoulder brought through
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14
Q

what is the babies descent encouraged by?

A
  • ncreased abdominal muscle tone
  • Braxton hicks in late staged of pregnancy
  • fundal dominance of uterine contractions during labour
  • increased frequency and strength of contractions during labour
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15
Q

what are some complications that could arise during labour?

A
  • failure to progress
  • malposition
  • suspected foetal compromise
  • vaginal birth after Caesarean section
  • operative deliveries
  • shoulder dystocia
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16
Q

what could cause failure to progress?

A
  • inadequate contractions
  • foetal malposition or malpresentation
  • cephalopelvic disproportion (relative or absolute)
  • obstructed labour - signs might be caput, moulding, haematuria, vulval and cervical swelling
  • maternal exhaustion
17
Q

what could cause foetal compromise?

A
  • uterine hyperstimulation
  • hypotension
  • poor foetal tolerance of labour
  • cord compression
  • infection
  • maternal disease
18
Q

how can you manage foetal compromise?

A
  • brady <100 → 3m call for help, 6m theatre, 6m baby out
    • give turbutlaine
  • rectify reversible cause like hypotension
    • is patient lying on back?
  • left lateral position
  • stop oxytocics
  • confirm compromise by blood sampling where possible
  • deliver by speediest route if unable to correct acidosis
19
Q

what is ‘vaginal birth after caesarean’ and what risks does it carry?

A
  • woman who previously had a C-section wants to have normal delivery

*increased risk of uterine rupture

20
Q

what are some indications for an instrumental delivery?

A
  • failure to progress in 2nd stage
  • foetal distress in 2nd stage
  • maternal reasons - exhaustion, spontaneous pneumothoraces, retinal detachement, cardiac so don’t want to push for too long
21
Q

what are some complications of an instrumental delivery?

A
  • failure
  • foetal trauma - cephalohaematoma
    • ventouse more common with
  • maternal trauma
    • forceps more common with
  • post-partum haemorrhage
  • urinary retention
22
Q

what are some indications for an emergency caesarean?

A
  • failure to progress
  • foetal distress
  • maternal reasons - PMH, trauma etc
  • malpresentation or malposition
  • failed instrumental delivery
23
Q

what is shoulder dystocia and what risks does it carry?

A

inability to deliver shoulders after delivery of head - anterior shoulder does not enter pelvic inlet

  • foetal death
  • asphyxia as chest wedged in canal, cord compressed -? hypoxic damage
  • birth trauma - Erbs, #
  • maternal trauma - cord tissue trauma, psychological
24
Q

what groups are at risk of shoulder dystocia?

A
  • macrosomic features
  • foetus of DM mother
  • rotational instrumental delivery
25
Q

what is the management for shoulder dystocia?

A
  • McRoberts position: flexion and abduction of the maternal hips, positioning the maternal thighs on her abdomen
  • suprapubic pressure to disimpact shoulder
    *works in 90%
    *if not cut symphysis pubis
26
Q

why might you induce labour?

A
  • prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
  • prelabour premature rupture of the membranes
  • diabetic mother > 38 weeks
  • pre-eclampsia
  • obstetric cholestasis
  • intrauterine fetal death

*BISHOPS score used!

27
Q

how do you induce labour?

A
  • membrane sweep as adjunct
  • vaginal prostaglandin dinoprostone
  • oral prostaglandin misoprostol
  • maternal oxytocin infusion
  • amniotomy
  • cervical ripening balloon
28
Q

what is a complication of inducing labour?

A

uterine hyperstimulation
- prolonged and frequent uterine contractions which may cause foetal hypoxia, acidaemia
- mx: remove prostaglandins and stop oxytocin infusion, tocolysis to delay delivery

Y4 Obs & Gyn (16 decks)

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