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Y4 cOGText > Labour > Flashcards

Labour Flashcards

1
Q

what happens during the first stage of labour?

A

early latent phase and an active phase

onset of regular painful contractions and cervical changes
…until full dilation and cervix is not palpable.

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2
Q

what happens in the early latent phase?

A

cervix becomes effaced, shortens in length and dilates up to 4cm

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3
Q

what happens in an active phase?

A

the cervix dilates from 4cm to full dilatation

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4
Q

what happens in the 2nd phase of labour?

A

full dilatation to delivery of the fetus

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5
Q

what happens in the 3rd phase of labours?

A

time between delivery of the fetus and delivery of the placenta

considered normal up to 30mins

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6
Q

what are the signs to indicate the separation of the placenta and membranes?

A

uterus contracts, hardens and rises

umbilical cord lengthens permanently

gush of blood variable in amount

placenta and membranes appears at introitus

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7
Q

when do you move from physiological management to active management for placental expulsion?

A

if there is excessive bleeding
failure to deliver the placenta within one hour
patient’s desire to shorten 3rd stage

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8
Q

when is delay in the 3rd stage diagnoses?

A

60 minutes of physiological management

30 minutes of active management

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9
Q

how much is the cervix expected to dilate in 4 hours during labour?

A

more than or equal to 2cm

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10
Q

what are uterotonic drugs?

A

uterine stimulants are medications given to cause a woman’s uterus to contract, or to increase the frequency and intensity of contractions

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11
Q

what are some examples of uterotonic drugs?

A

oxytocin

syntometrine (ergometrine and oxytocin)

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12
Q

what are Braxton Hicks contractions?

A

contractions which are believed to be the uterine muscles preparing for labour

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13
Q

the initiation of labour involves what changes to progesterone, oestrogen and prostaglandin action?

A

progesterone withdrawal

increases in oestrogen and prostaglandin action

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14
Q

what hormone initiates and sustains contractions?

A

oxytocin

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15
Q

what are the 7 cardinal movements?

A 
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
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16
Q

how many women will achieve a normal delivery?

A

60% normal delivery
25% caesarean section
15% forceps

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17
Q

what are situations of abnormal labour?

A 
malpresentation
malposition (OP / OT)
too early (<37wks)
too late (>42wks)
too painful
too quick (<2hrs)
too long
fetal distress
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18
Q

what are the 3 Ps of labour?

A

power
passages
passenger

19
Q

what problems can their be with power?

A

inadequate contractions either in the strength or frequency of contractions

20
Q

what problems can there be with passages?

A

trauma
shape
cephalopelvic disproportion

21
Q

what problems can there be with passenger?

A

big baby

malposition causing a relative cephalo-pelvis disproportion

22
Q

in labour there is a vaginal examination every 4 hours to assess what?

A

cervical dilatation
descent of presenting part
signs of obstruction

23
Q

what are some different types of forceps?

A

outlet forceps
mid-cavity/low-cavity forceps
rotational forceps

24
Q

what forceps are used for Wrigley’s forcep?

A

outlet forceps

25
Q

what forceps are used for Neville-Barnes, Andersons & simpsons?

A

Mid-cavity/low-cavity forceps

26
Q

what forceps are used for Kielland’s forceps

A

rotational forceps

27
Q

what are the requirements for forceps delivery?

A 
FORCEPS
Fully dilated cervix
Occipitoanterior position
Ruptured membranes
Cephalic presentation
Engaged presenting part
Pain relief
Sphincter empty
28
Q

what are the indications for operative vaginal delivery?

A

failure to progress to 2nd stage of labour

fetal distress

maternal exhaustion

29
Q

what are the advantages of caesarean section?

A

avoid tears and so long-term urinary/faecal incontinence
no injury to cervix/high vaginal areas
less chance of neonatal trauma

30
Q

disadvantages of caesarean section?

A

major surgery so risk of haemorrhage, infection, visceral injury, venous thromboembolism

longer hospital stay & recovery

31
Q

what are the three potential injuries with ventouse delivery?

A

caput succedaneum

cephalohaematoma

subgaleal haemorrhage

32
Q

when does induction of labour occur?

A

when the risk to mother or baby of continuing pregnancy exceeds the risks of inducing labour

33
Q

what are indications for induction?

A 
prolonged pregnancy (>42wks)
pre-eclampsia
placental insufficiency &amp; IUGR
antepartum haemorrhage
rhesus
diabetes mellitus
chronic renal disease
34
Q

what does the Bishop score look at?

A 
dilatation
effacement
station
consistency
cervix position
35
Q

what are some methods of induction?

A

stripping of membranes / sweep

AROM

36
Q

what is a partogram?

A

graphic representation of maternal and fetal data during labour and often started as soon as woman is admitted to the delivery suite

37
Q

what is labour pain due to?

A

compression of para-cervical nerves and myometrial hypoxia during cotnractions

38
Q

what types of analgesia are available in labour?

A 
narcotic analgesia (morphine, pethidine, remifentanil)
inhalation (entonox)
TENS
Epidural
Spinal
Pudendal nerve block
39
Q

what is the mnemonic for looking at CTGs?

A

DR C BRAVADO

40
Q

what is DR C BRAVADO?

A 
DR - define risk
C - contractions
BRA - baseline rate
V - variability
A - accelerations
D - decelerations
O - overall impression/diagnosis
41
Q

how many contractions do you expect in labour?

A

3-5 every 10 minutes

42
Q

how much should a fetal baseline heart rate be?

A

110 - 160 beats per minute

43
Q

where does normal fetal pH lie?

A

7.25 - 7.35

44
Q

what are the 4Hs and 4Ts of maternal collapse?

A

Hypovolaemia
Hypoxia
Hypo/hyperkalaemia
Hypothermia

Thromboembolism
Toxicity
Tension pneumothorax
Tamponade

Y4 cOGText (9 decks)

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