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Repro > Labour > Flashcards

Labour Flashcards

1
Q

Braxton Hicks contractions? (5)

A 
Irregular
Usually occur from the third trimester
Initially mild and crampy, can be strong
Not felt by everyone
Last for a few minutes then disappear
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2
Q

Signs of labour?

A

Show (mucus plug from the cervix)
Rupture of membranes
Regular painful contractions

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3
Q

Scoring system for labour progression?

A

Bishop Score

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4
Q

Situations where it may be beneficial to induce early labour?

A

Macrosomia
Reduced foetal movements
Pre-eclampsia
Premature rupture of membranes

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5
Q

What is assessed to calculate a Bishop score?

A 
Foetal station
Cervical position
Cervical dilatation
Cervical effacement
Cervical consistency
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6
Q

A score of (?) or less indicates labour will not occur without being induced?

A

5 or less

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7
Q

Two main methods for induction of labour?

A

Membrane sweep

Vaginal pessaries

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8
Q

If a membrane sweep is successful, labour should start within?

A

48 hours

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9
Q

What do vaginal pessaries release?

A

Prostaglandin E2, stimulating cervical ripening (Dinoprostone)

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10
Q

What can be used if other methods are unsuccessful?

A

Artificial rupture of membranes and an oxytocin infusion

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11
Q

What is used to induce labour if there is foetal death during pregnancy?

A

Misoprostol or mifepristone

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12
Q

Indications for continuous CTG monitoring? (5) (SOMPA)

A 
Sepsis
Oxytocin
Meconium
Pre-eclampsia (with blood pressure >160/110)
Antepartum haemorrhage
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13
Q

What does cardiotocography (CTG) measure? (5)

A 
Contractions
Baseline rate
Variability
Accelerations
Decelerations
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14
Q

Synthetic oxytocin for starting labour?

A

Syntocinon

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15
Q

Start contractions?

A

Ergometrine

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16
Q

Combination drug for starting labour and contractions?

A

Syntometrine

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17
Q

Pessary induction of labour?

A

Vaginal prostaglandins

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18
Q

Third stage of labour?

A

Delivery of the placenta

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19
Q

Why active management of third stage of labour?

A

Reduces the risk of postpartum haemorrhage

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20
Q

Management of third stage?

A

Empty bladder
IM syntocinon after birth of baby
Cord clamping and cutting within 1 minute of birth
Wait for uterine contraction
Controlled cord traction
Examination of placenta after delivery (aim to deliver in one piece)

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21
Q

Elective caesarean indications?

A 
Previous caesarean
Placenta praevia
Breech presentation
Cephalopelvic disproportion
Female choice
IUGR
Post-maturity
Uncontrolled HIV
Cervical cancer
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22
Q

Emergency caesarean, category 1?

A

Immediate threat to life of the mother or baby. Decision to delivery target time 30 mins

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23
Q

Emergency caesarean, category 2?

A

No imminent threat to life, but required due to compromise of the mother or baby. Decision to delivery target time 75 minutes

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24
Q

Emergency caesarean, category 3?

A

Delivery is required but mother and baby are stable

25
Q

Emergency caesarean, category 4?

A

Elective caesarean

26
Q

Anaesthetic in caesarean?

A

Spinal block, safer and faster recovery than general

27
Q

Complications of caesarean?

A 
Risk of anaesthetic
General surgical risks (bleeding, infection, pain, VTE)
Damage to local structures
Effect on abdominal organs
Effect of future pregnancies
Effect on baby
28
Q

Caesarean effects on future pregnancies?

A

Increased risk of:

  • repeat caesarean
  • uterine rupture
  • placenta praevia
  • stillbirth
29
Q

Vaginal birth after caesarean?

A

VBAC
Yes, provided reason unlikely to reoccur
Individual assessment necessary
Success rate about 75%

30
Q

Contraindications of vaginal birth after caesarean (VBAC)?

A

Previous uterine rupture
Classical caesarean scar
Other normal contraindications to vaginal delivery (e.g. placenta praevia)

31
Q

VTE after caesarean section?

A

Emergency c-section need 10 days of low molecular weight heparin
Elective do not, unless other predisposition

32
Q

What happens in amniotic fluid embolism?

A

Amniotic fluid, containing foetal cells, passes into the mother’s blood and leads to an immune response from the mother

33
Q

Risk factors for amniotic fluid embolism?

A

Increasing maternal age

Induction of labour

34
Q

Presentation of amniotic fluid embolism?

A 
SOB
Cough
Fever
Respiratory failure
Tachycardia
Hypotension
Haemorrhage
35
Q

Uterine rupture risk factors?

A 
VBAC
Previous uterine surgery
Increased BMI
High parity
Induction of labour
36
Q

What is shoulder dystocia?

A

Babies shoulder gets stuck behind the pubic symphysis after the head has been delivered

37
Q

Risk factors for shoulder dystocia?

A

Macrosomia
Maternal obesity
Diabetes mellitus
Dysfunctional labour patterns

38
Q

Management of shoulder dystocia? (6)

A 
Episiotomy
McRoberts manoeuvre
Pressure to anterior shoulder
Rubins manoeuvre
Woods Screw manoeuvre
Zavanelli manoeuvre
39
Q

McRoberts manoeuvre?

A

Hyperflexing the mother at the hip

40
Q

Rubins manoeuvre?

A

Reaching into the vagina to put pressure on the posterior aspect of the stuck shoulder

41
Q

Complications of shoulder dystocia?

A

Foetal hypoxia
Erb’s palsy
Perineal tears
Postpartum haemorrhage

42
Q

Cord prolapse?

A

Umbilical cord descends below the presenting part of the foetus

43
Q

Biggest risk factor for cord prolapse?

A

Non cephalic lie after 37 weeks gestation

44
Q

Diagnosing cord prolapse?

A

Suspect when signs of foetal distress on CTG
Diagnosed during vaginal examination at time of labour
Speculum can be used to confirm diagnosis

45
Q

Management of cord prolapse?

A

Emergency c-section
Presenting part of baby can be pushed back in to prevent compression
Tocolytic medication (nifedipine) can be used to slow contractions before c-section
Don’t touch the cord as this can cause vasospasm, should be kept warm and moist

46
Q

Indications for assisted delivery?

A

Failure to progress
Foetal or maternal distress
Control of the head in various foetal positions

47
Q

Risks of instrumental delivery?

A

Increased haemorrhage

Increased tears/requirement for episiotomy

48
Q

Ventouse?

A

Suction cup on babies head

49
Q

Main complication of ventouse?

A

Cephalohematoma on babies head

50
Q

Forceps delivery?

A

Metal tongs to grip babies head

51
Q

Main complication of forceps delivery?

A

Facial nerve palsy, can leave bruises

52
Q

Definitions of postpartum haemorrhage?

A

500ml normal after vaginal delivery
1L normal after c-section
So anything above this

53
Q

Risk factors for postpartum haemorrhage (PPH)?

A 
Previous PPH
Multiple pregnancy
Large baby
Pre-eclampsia
Anaesthetic
Grand multipara (>5)
Slow or failure to progress in second stage of labour
54
Q

Causes of PPH? (4Ts)

A

Tone
Trauma
Tissue
Thrombin (bleeding disorders)

55
Q

Preventative measures in PPH?

A

Treat antenatal anaemia
Empty bladder for delivery
Oxytocin for third stage of labour
Tranexamic acid can be used IV during third stage in a c-section

56
Q

Management of PPH?

A

Resuscitation (ABCDE approach)
Large bore cannula
Group and cross match
In severe cases activate major haemorrhage protocol

57
Q

Mechanical treatment options in PPH?

A

Rubbing the uterus from the abdomen

Catheterisation

58
Q

Medical treatment options in PPH?

A

IV 10 units of syntocinon/500mg ergometrine
Carboprost
Misoprostol
Tranexamic acid

59
Q

Surgical treatment options in PPH?

A

Balloon tamponade
B-Lynch suture
Uterine artery ligation
Hysterectomy (last resort)

Repro (9 decks)

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