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4th Year Obs and Gynae > Labour > Flashcards

Labour Flashcards

1
Q

What are some of the risks for preterm labour?

A 
Acute illness
Low BMI
PROM
Multiple pregnancy
Polyhydramnios
Cervical surgery / short cervix / incompetence
Smoking
Uterine abnormalities
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2
Q

What are some of the indications for continuous foetal monitoring during labour?

A

Prematurity
Meconium stained liquor
Decelerations heard on sonicaid
Oxytocin use

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3
Q

What should a foetal heart rate be baseline?

A

110-160

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4
Q

Define labour:

A

Regular uterine contractions with progressive cervical change
Occurs in 3 stages

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5
Q

How many deliveries are induced?

A

1/5 (20%)

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6
Q

What are some of the indications that may lead t the induction of labour?

A 
Gestation >41 weeks
Large for dates baby
Gestational diabetes
Pre eclampsia
IUGR
Intrauterine death
Maternal request
Premature rupture of membranes
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7
Q

When is a ventouse delivery contrainidcated?

A

In a malpresentation of the foetus presenting face first vaginally.

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8
Q

What abnormal foetal lie carries an increased risk of cord prolapse?

A

Transverse lie

Especially in PROM

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9
Q

What are some of the foetal outcomes in cord prolapse?

A

Hypoxia
Cerebral palsy
Hypoxic encephalopathy
Death

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10
Q

What can occur to the cord if it prolapses?

A

Vasospasms or compression, leading to reduced blood flow to the foetus

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11
Q

What is the management for cord prolapse?

A

Immediate call for help

Deliver ASAP either vaginally or c section depending on stage of descent etc

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12
Q

What is the most common foetal malpresentation?

A

Breech

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13
Q

What are the 3 types of breech?

A

Footling
Complete
Frank breech

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14
Q

How is prolonged labour defined?

A

When the cervix is dilated <2cm after 4 hours of active labour.

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15
Q

What is a normal timeframe for the 3rd stage of labour?

A

Placental delivery tends to occur within 5-10 minutes after the baby is delivered, however anywhere up to 30 mins is normal.
In physiological management 60mins< would be considered delayed

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16
Q

what time frame is classified as delay of second stage labour in nulliparous and multiparous?

A

Nulliparous - 2 hours

Multiparous - 1 hour

17
Q

When should the cord be clamped?

A

Once it has stopped pulsating - anytime up to 3 minutes is appropriate.

18
Q

What are the 3 classic signs that the placenta has detached and the membrane?

A

Umbilical cord permanently lengthens
Uterus contracts, hardens and rises
Gush of blood (variable in amount)

19
Q

What are some of the complications of active management for 3rd stage?

A

Nausea and vomiting
Haemorrhage
Increased risk of needing blood transfusion

20
Q

What are some reasons for active management instead of physiological management of 3rd stage of labour?

A

Patient request
Excessive hemorrhage
Time >60 mins

21
Q

How do we actively manage the third stage of labour?

A

Oxytocin or syntometrine infusion
Cord clamping and controlled
Bladder empyting

22
Q

How do we medically induce labour?

A 
Vagianl prostaglandins  (PGE2)
Oxytocin infusion
23
Q

How do we surgically induce labour?

A

Membrane sweep
Artificial amniotomy (rupture of membranes)
Cervical balloon

24
Q

WHat are some of the risks attached to inducing labouur?

A 
Increased risk of surgical delivery
Uterine hyperstimulation
Failed induction
Cord prolapse
Uterine rupture
(infections)
25
Q

How should a cord prolapse be managed during labour?

A

Call for help immediately

Immediate delivery of baby (forceps if fully dilated or c section)

26
Q

What are some of the risk factors for shoulder dystocia?

A 
Large for dates
Macrosomia
DM
Maternal BMI >30
IOL
Prolonged first and second stage
Forceps delivery
Oxytocin
27
Q

What are some of the risks to the foetus in shoulder dystocia?

A 
Erb's palsy / Klumpke's palsy
Cerebral palsy
Hypoxic encephalopathy
Brachial plexus injury of the newborn
Death
28
Q

What are some of the risks to the mother in shoulder dystocia?

A

Significant post partum haemorrhage

Tear / perineal trauma

29
Q

Using the HELPERR mnemonic, describe how shoulder dystocia is managed?

A

H - call for Help
E - Evaluate for episiotomy
L - Legs (McRoberts maneuver)
P - Suprapubic Pressure
E - Enter manoeuvres (ie internal rotation of foetus anterior shoulder)
R - Remove posterior arm
R - Roll patient onto all fours and begin cycle

4th Year Obs and Gynae (7 decks)

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