labour Flashcards by Rimpi Das

a) what is a category 1 emergency C-section?

b) how soon should it happen?

a) there is immediate threat to the life of the woman or foetus
b) <30 mins

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what is a category 2 emergency C-section?

maternal/foetal compromise, but not immediately life-threatening

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what is a category 3 emergency C-section?

no maternal / foetal compromise but needs early delivery

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what is a category 4 C-section?

elective - delivery timed to suite woman / staff

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commonest cause for an emergency C-section?

failure to progress in labour

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indications for C-section?

breech presentation
unstable / transverse / oblique lie
twins where first one is not cephalic
maternal conditions (e.g. cardiomyopathy)
HSV in third trimester
placenta praevia
maternal diabetes
prev major shoulder dystocia
prev 3rd/4th perineal tear

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when are elective C-sections usually planned for?

> 39 weeks

- reduces risk of RDS

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purpose of corticosteroids in C-section?

if a C-section is happening <39 weeks, maternal corticosteroids stimulate surfactant secretion in foetal lungs

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3 types of breech presentation?

complete breech (bum first, legs tucked in)
frank breech (bum first, legs pointed up to head)
footling breech (one leg first)

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what is done pre-operatively in C-section?

FBC
Group and Save (in case they need blood)
H2-receptor antagonist
VTE risk score calculated

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why are ranitidine and metoclopramide given pre-operatively in C-section

to stop them vomiting on their back

- risk of aspirating the vomit

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type of anaesthesia in C-section?

regional

- sometimes epidural is added

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indications for general anaesthetic in C-section?

contraindication to regional anaesthetic
failure of regional anaesthetic
need to expedite delivery asap (common in section 1)

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positioning in C-section? why?

left lateral tilt of 15 degrees

- reduces risk of supine hypotension due to aortocaval compression

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why is a Foley’s catheter inserted in C-section?

to drain the bladder and stop bladder injury

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layers to get through in C-section?

skin
Camper’s fascia
Scarpa’s fascia
rectus sheath
rectus muscle
abdominal peritoneum
visceral peritoneum
gravid uterus

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what is the purpose of oxytocin 5 IU/ml in C-section?

aids the delivery of the placenta

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risks of vaginal birth after a C-section?

risk of scar rupture
75% success rate, compared to 90% in prev vaginal delivery
increased risk of placenta praevia/accreta + pelvic adhesions

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immediate maternal complications of C-section?

PPH (>1000ml)
wound haematoma
intra-abdo haemorrhage
bladder / bowel trauma

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immediate foetal complications of C-section?

- foetal lacerations

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infections that could come from C-section?

UTI
endometritis
resp (esp if gen anaesthetic used)

late complications of C-section?

placenta praevia
subfertility
psychological issues (e.g. regret)
caesarean scar ectopic pregnancy

indications for labour to be induced?

prolonged gestation (>40 weeks)
premature rupture of membranes >37 weeks
maternal health problems
foetal growth restriction
intrauterine foetal death

absolute contraindications for induction of labour?

cephalopelvic disproportion
major placenta praevia
vasa praevia
cord prolapse
transverse lie
active genital herpes
prev classical C-section

relative contraindications for induction of labour?

- breech presentation - triplet / high order pregnancy - >1 prev low transverse C-sections

methods to induce labour?

- vaginal prostaglandins - amniotomy (bishop score 7 or more) - membrane sweep

what does bishop score tell you?

- it checks "cervical ripeness" - 7 or higher = induction of labour possible - less than 4 = labour unlikely to progress naturally, use a prostaglandin

what needs to be checked before induction of labour?

- foetal heart rate | - using cardiotocography

complications of induction of labour?

- failure of induction - uterine hyperstimulation - cord prolapse - infection - pain - increased need for further intervention - uterine rupture (rare)

which features of the cervix are considered in bishop scoring?

- dilation - length - foetal station - consistency - position

why is induction of labour offered to women with prolonged gestation?

reduces the risk of stillbirth

what is foetal station measured in relation to?

ischial spine

2 main instruments used in operative vaginal delivery?

- ventouse | - forceps

how long should you try to deliver with an instrument for?

if after 3 contractions and pulls with any instrument, there is NO progress, give up

types of ventouse?

- silastic cup - "kiwi" cup (disposable) - bird cup

condition for use of a silastic cup in delivery?

occipital-anterior position

pros of ventouse delivery?

- less maternal perineal injuries | - less pain

cons of ventouse delivery?

- lower success rate - more cephalhaematoma - more subgaleal haematoma - more retinal haemorrhage

when are Rhodes forceps used?

occipital-anterior position

when are Wrigley's forceps used?

at C-section

when are Kielland's forceps used?

rotational deliveries

pros of forceps?

- fewer foetal injuries | - doesn't require maternal effort

cons of forceps?

higher rate of 3rd/4th degree tears

maternal indications for instruments in vaginal delivery?

- nulliparous woman who has no delivered after 2 hours of active pushing - multiparous no delivery within 1 hour of active pushing - maternal exhaustion - no urge to push (due to anaesthesia)

foetal indications for instruments in vaginal delivery?

suspected foetal compromise on CTG / blood sample

absolute contraindications for instrumental delivery?

- unengaged foetal head - incompletely dilated cervix - true cephalo-pelvic disproportion (head too big to pass) - breech + face presentations - preterm gestation <34 weeks for ventouse

relative contraindications for instrumental delivery?

- acute foetal distress - non-engaged 2nd twin - prolapsed cord

pre-requisites for instrumental delivery?

- fully dilated - ruptured membranes - cephalic presentation - defined foetal position - empty bladder - adequate pain relief - adequate maternal pelvis

where does foetal head need to be for instrumental delivery?

- level of ischial spines | - no more than 1/5 palpable per abdomen

foetal complications from instrumental delivery?

- neonatal jaundice - scalp lacerations - cephalhaematoma - sobgaleal haematoma - facial bruising - facial nerve damage - skull fractures - retinal haemorrhage

maternal complications from instrumental delivery?

- 3rd/4th degree vaginal tear (esp forceps) - VTE - incontinence - PPH - shoulder dystocia - infection