Labour Flashcards
Within how long should an emergency C-sec take place from threat to mother or baby’s life?
30mins
What are the 2 most common reasons to perform emergency C-sec?
Failure to progress
Suspected/confirmed foetal compromise
What are H2 receptor antagonists used for in C-sec?
Prevent Mendelson’s syndrome
What is Mendelson’s syndrome?
Aspiration of gastric contents into the lung
Which anaesthetic options can be used in C-sec?
Epidural
Spinal
GA
What layers are incised during C-sec?
Skin Camper's fascia Scarpa's fascia Rectus sheath Rectus muscle Abdominal peritoneum Visceral peritoneum Uterus
C-sec carries in increases risk of uterovaginal prolapse, neonatal infection and perineal trauma true/false
False
It is lower risk for all of these as well as incontinence and later still birth
Give indications for induction of labour?
Prolonged gestation
Premature membrane rupture
Maternal health problems (pre-eclampsia, DM)
Foetal growth restriction
What is the management of preterm rupture of membranes >37 weeks gestation?
Expectant waiting for 24 hours and then induction
What is the management of rupture of membranes <34 weeks gestation?
Delay labour induction unless there are other negative factors
What are the absolute contraindications to induction of labour?
Major PP VP Cord prolapse Transverse lie Active genital herpes Prev C-sec
What are relative contraindications to C-sec?
Breech presentation
Triplets (or more !!)
2+ previous low transverse C-sec
What are the three main methods of labour induction?
Vaginal prostaglandins
Amniotomy
Membrane sweep
How do vaginal prostaglandins induce labour?
Ripen the cervix
Stimulate contraction of sm of uterus
What is an amniotomy?
Artificial rupture of membranes with amniohook
Causes prostaglandin release
What is a membrane sweep?
Insert gloved finger to “sweep” around foetal membranes to separate them from the decidua
What does the Bishop score assess?
Cervical ripeness
What Bishop score indicates induction of labour is possible?
> =7
How is foetus monitored if oxytocin given during labour?
CTG
What is an operative vaginal delivery?
Use of instrument to aid delivery of the uterus
What are the two main instruments used in operative delivery?
Ventouse
Forceps
What is a ventouse?
Instrument used which attaches at the foetal head with vaccuum
What are the two most common types of ventouse?
Kiwi
Silastic cup
In which foetal position may a silastic cup be used?
OA
How is a forceps delivery carried out?
Blades applied to either side of the head and gentle traction applied in time with contractions
Which forceps type is used a C-sec?
Wrigley’s
Which type of forceps is used for rotational delivery?
Klielland;s
Which maternal factors would be an indication for operative delivery?
Inadequate progress (2hrs nulliparous, 1hr multiparous) Maternal exhaustion Congenital heart disease HTN Intracranial pathologies
Which foetal factors would be indications for operative delivery?
Foetal compromise
APH
Give examples of absolute contraindications to any operative delivery
Unengaged foetal head
Incompletely dilated cervix
(in single preg)
Breech presentation
Give absolute contraindications for ventouse delivery?
Perterm
High likelihood of coag disorder
Which foetal complications may arise from operative delivery?
Scalp laceration Bruising Facial nerve damage Skull fracture Retinal haemorrahge
Which maternal complications may arise as a result of operative delivery?
Vaginal tear VTE Incontinence PPH Shoulder dystocia Infection
Define premature rupture of membranes
Rupture of membranes 1 hour prior to onset of labour >=37 weeks gestation
Define pre-term premature rupture of membranes
Rupture <37 weeks gestation
What do the foetal membranes consist of?
Chorion
Amnion
How do the foetal membranes become weaker for labour?
Through apoptosis and enzyme-mediated collagen breakdown
What are the three main causes of early membrane rupture?
Physiological early activation
Infection
Genetic predisposition
What are the major risk factors for early membrane rupture?
Smoking Prev event Vaginal bleeding Invasice procedures Multiple preg Polyhydramnios Cervical insuff
Even if fluid can be seen leaking from vagina, speculum exam is required
true/false
False
Get woman to lay on back for 30mins - should see pooling of fluid
Ask to cough and amniotic fluid should come out
What investigation should be performed in all early membrane rupture?
High vaginal swab
