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Reproduction SB > Labour > Flashcards

Labour Flashcards

1
Q

what are the 3 key factors during labour

A

POWER: Uterine Contraction

PASSAGE: Maternal Pelvis

PASSENGER: Fetus

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2
Q

what hormone initiates and sustains contractions

A

oxytocin

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3
Q

what other roles does oxytocin have

A

acts on decidual tissue to promote prostaglandin release

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4
Q

what hormone makes the uterus contract

A

oestrogen

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5
Q

what is the other function of oestrogen in labour

A

promotes prostaglandin production

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6
Q

what its the role of progesterone

A

This keeps the uterus settled.
It prevents the formation of gap junctions
Hinders the contractibility of myocytes

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7
Q

what hormone changes cause the initiation of labour

A

progesterone withdrawal

increase in oestrogen and prostaglandin action

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8
Q

what hormone from the placenta is likely involved in starting the changes leading to labour

A

corticotrophin-releasing hormone (CRH)

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9
Q

there are 3 stages of labour - what is involved in stage 1

A

Commences with onset of regular painful contractions - split into latent and active phase

  • Latent phase = 3-4cms dilatation
  • Active phase = 4cms -10cms (full dilatation)
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10
Q

there are 3 stages of labour - what is involved in stage 2

A

Full dilatation achieved

Delivery of baby

Divided into pelvic/passive phase [head descends down pelvis] and active phase [when the mother pushes]

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11
Q

there are 3 stages of labour - what is involved in stage 3

A

expulsion of placenta and membranes after birth of baby

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12
Q

after what time is the decision made to go and remove the placenta under GA

A

1 hour

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13
Q

what can be given to help the mother deliver the placenta

A

oxytocic drugs

  • oxytocin 10 units
  • Syntometerine

controlled cord traction

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14
Q

what changes in the cervix happen for labour

A

Cervical softening and ripening

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15
Q

what are Braxton Hicks contractions

A

Tightening of the uterine muscles, thought to aid the body prepare for birth

Can start 6 weeks into pregnancy but not usually felt until second or third trimester

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16
Q

what are true labour contractions

A

pain described as a wave

- starts low, rises until it peaks, and finally ebbs away

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17
Q

how will the mothers abdomen feel during contraction

A

hard

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18
Q

where about do the contractions start in the uterus

A

the fundus

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19
Q

what are Braxton Hicks Contractions also called

A

False labour

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20
Q

what are features of a Braxton Hicks Contractions that can help you differentiate from true contractions

A

irregular
do not increase in frequency or intensity
resolve eventually
relatively painless

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21
Q

what cause real labour contractions

A

oxytocin

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22
Q

what are features of real labour contractions

A

evenly spared

time between them gets shorter

get more intense and painful

promotes thinning of the cervix

don’t resolve

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23
Q

what is the ostia

A

distal tube opening of the infundibulum of uterine tube into the abdominal cavity

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24
Q

where do the contractions synchronise from

A

both ostia

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25
Q

what shape of pelvis is the most suitable female pelvis shape

A

Gynaecoid pelvis

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26
Q

what are the other shapes of pelvis called

A

Anthropoid Pelvis
Android Pelvis.
Platypelloid Pelvis

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27
Q

what is the function of liquor

A

nurtures and protects fetus and facilitates movement

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28
Q

what colour should the liquor be

A

clear

- red/pink suggests bleeding

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29
Q

what is the normal fetal presentation

A

Longitudinal Lie
Cephalic Presentation
Presenting part = vertex

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30
Q

hence, what is called normal position in labour

A

occipitoanterior

with head engaging occipital-transverse

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31
Q

what are the major fontanelles in the fetal skull

A

anterior fontanelle [diamond shaped]

posterior fontanelle

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32
Q

how do the head’s of the foetus in 95% of vertex presentation appear

A

flexed

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33
Q

what position does a flexed vertex baby go into

A

NORMAL

i.e. occipitoanterior

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34
Q

what position does an extended or deflexed vertex baby go into

A

occipitoposterior OR transverse

35
Q

how is the decent of the head referenced

A

abdominal fifths

36
Q

what is crowning

A

Appearance of a large segment of fetal head at the introitus

Labia are stretched to full capacity

37
Q

what may be required, to prevent trauma to the anal sphincters due to crowing

A

episiotomy

38
Q

what is the bishop score used for

A

to determine if it is safe to induce labour

39
Q

what are the 5 elements of the Bishops score

A 
Position
Consistency
Effacement
Dilatation
Station in Pelvis
40
Q

what are analgesic options for labour

A 
Paracetamol/ Co-codamol
TENS [electrical pulses]
Entonox [inhalation agents]
Diamorphine
Epidural 
IV Remifentanyl
Combined spinal/epidural
41
Q

why do mothers on epidurals need to be monitored

A

as it can cause resp depression

42
Q

what is a normal amount of blood loss in labour

A

< 500mls

43
Q

what is a abnormal amount of blood loss in labour

A

> 500 mls

44
Q

what is a significant amount of blood loss in labour

A

> 1500 mls

45
Q

what are the signs that indicate placental separation

A

Uterus contracts, hardens and rises

Umbilical cord lengthens permanently

Gush of blood variable in amount

46
Q

how is haemostasis achieved after delivery

A

Tonic contraction of uterine muscle strangulates blood vessels

Thrombosis of the torn vessel ends: pregnancy is a hyper-coaguable state

47
Q

what is puerperium

A

6 week period after delivery as tissues return to non-pregnant state

48
Q

in the puerperium period, there can be a lot of discharge, what are the different types?

A

Lochia: Vaginal discharge containing blood, mucus and endometrial castings

Rubra (fresh red)

Serosa (brownish-red, watery)

Alba (yellow)

49
Q

what induces lactation

A

placental expulsion

50
Q

what is Colostrum

A

name given to milk produced by mothers

51
Q

what is Colostrum rich in

A

immunoglobulin

52
Q

what is in an epidural anaesthesia

A

Levobupivacaine +/- Opiate

53
Q

why is epidural anaesthetic useful

A

Does not impair uterine activity

[May inhibit progress during stage 2[

54
Q

what are complications of epidural anaesthetic

A 
Hypotension
Dural puncture 
Headache
Back pain
Atonic bladder
55
Q

how can progress be assessed in labour

A

Cervical dilatation

Descent of presenting part

Signs of obstruction

56
Q

when should you suspect delay in stage

A

If Nulliparous <2cm dilation in 4 hours

Parous <2cm dilation in 4 hours or slowing in progress

57
Q

what should you think about when considering a cause for failure to progress

A

3 P’s

Power
Passage
Passenger

58
Q

what dysfunction in power could lead to failure to progress

A

Inadequate contractions: frequency and/or strength

59
Q

what dysfunction in passages could lead to failure to progress

A

Short stature / Trauma / Shape

60
Q

what dysfunction in passenger could lead to failure to progress

A

Big baby

Malposition - relative cephalo-pelvic disproportion

61
Q

what is commenced as part of assessing progress as soon as a women enters the labour ward

A

the partogram

62
Q

what tools are used to assess fetal well being

A

Doppler auscultation of fetal heart
Cardiotocograph (CTG) (+/- STAN)
Colour of amniotic fluid

63
Q

when is doppler auscultation of the fetal done

A

Stage 1:
During and after a contraction
Every 15 minutes

Stage 2:
Every 5-10 minutes

64
Q

what are risk factors for fetal hypoxia

A 
Small fetus
Preterm / Post Dates
Antepartum haemorrhage
Hypertension / Pre-eclampsia
Diabetes
Epidural analgesia
Induction / Augmentation of labour
65
Q

if a baby has any risk factors for fetal hypoxia what is done

A

continous monitoring of the fetal heart

66
Q

what are acute cause of fetal distress

A 
Abruption
Vasa Praevia
Cord Prolapse
Uterine Rupture
Feto-maternal Haemorrhage
Uterine Hyperstimulation
Regional Anaesthesia
67
Q

what are subacute cause of fetal distress

A

hypoxia

68
Q

what does a CTG monitor/record

A 
contractions
decelerations 
accelerations 
variability 
baseline HR
69
Q

what is the normal baseline HR

A

110-150 bpm

tachycardia > 150
bradycardia < 110

70
Q

what is the normal variability in fetal HR

A

5-25 bpm

71
Q

how is CTG results classified

A

normal
non-reassuring
abnormal

72
Q

Mx of fetal distress

A

Change maternal position

IV Fluids

Stop syntocinon

Consider tocolysis - Terbutaline 250 micrograms s/c

Maternal assessment - Pulse / BP / Abdomen / VE

Fetal blood sampling

Operative Delivery

73
Q

fetal blood sampling shows scalp pH = what result would be normal, baseline and abnormal

A

pH >7.25 = normal

7.20 - 7.25 = borderline

< 7.20 = abnormal

74
Q

what action would a borderline fetal blood sampling require

A

repeat in 30 mins

75
Q

what action would an abnormal fetal blood sampling require

A

deliver the baby

76
Q

what length of duration is ok in a women that has never given birth before for stage 2 of labour

A

no epidural < 2 hrs

epidural < 3 hrs

77
Q

what length of duration is ok in a women that has given birth before for stage 2 of labour

A

no epidural < 1 hrs

epidural < 2 hrs

78
Q

what is Ventouse

A

vacuum-assisted vaginal delivery or vacuum extraction (VE)

79
Q

what is ventouse associated with

A

increased failure
increased cephalohaematoma
increased retinal haemorrhage
increased maternal worry

decreased anaesthesia
decreased vaginal trauma
decreased perineal pain

80
Q

what are indications of C-section

A 
previous CS
fetal distress
failure to progress in labour
breech presentation
maternal request
81
Q

C-sections are associated with 4x greater mortality - what leads to morbidity

A

sepsis, haemorrhage, VTE, trauma, TTN, subfertility, complications in future pregnancy

82
Q

what are indications for inductions of labour

A

Maternal = Pre-eclampsia, Poor obstetric history

Fetal = Suspected IUGR, Rhesus isoimmunisation, Antepartum Haemorrhage

Both= Post Dates Pregnancy, DM, Obstetric Cholestasis

83
Q

what are methods for induction

A

Prostaglandins - PGE2 Dinoprostone (Prostin gel / Propess pessary)

Mechanical - Membrane sweep, Foley Balloon Catheter

Amniotomy

IV Syntocinon [synthetic oxycontin]

Reproduction SB (30 decks)

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