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Y5 - Obstetrics & Gynaecology > Labour > Flashcards

Labour Flashcards

1
Q

What is the definition of labour?

A

Painful contractions of the uterus with dilation and effacement of the cervix.

This often causes a “show” - a mucus plug from the cervix.

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2
Q

What are the stages of labour?

A

First stage: initiation to full cervical dilation.

Second stage: full dilation to delivery.

Third stage: delivery of fetus to delivery of placenta.

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3
Q

What three mechanical factors determine progress in labour?

A

Power of the uterus.

Passage through the pelvis.

Passenger - diameter of fetal head.

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4
Q

What causes effacement and dilation?

A

The uterus pulling up on the cervix and pushing the fetal head down into it.

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5
Q

What is the ideal presentation of the head? And what are the other presentations?

A

Vertex - fully flexed.

Others: Deflexed, extended, hyperextended.

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6
Q

What is the ideal rotational position of the head?

A

Occipito-anterior.

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7
Q

Describe the movements of the head during delivery.

A

Engagement in occipito-transverse.

Descent and flexion.

Rotation to occipito-anterior.

Descent.

Extension to deliver the head.

Restitution and delivery of shoulders.

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8
Q

Are all contractions in the third trimester significant?

A

No - Braxton Hicks contractions.

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9
Q

What chemicals are involved in labour?

A

Prostaglandins: cervical effacement and dilation.

Oxytocin: stimulation of contractions of uterus.

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10
Q

When is the cervix fully dilated?

A

10cm.

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11
Q

What are the phases in the first stage of labour?

A

Latent phase - dilation up to 3cm that may take several hours.

Active phase - cervical dilation at 1cm/h (primips) or 2cm/h (multips).

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12
Q

What are the sub-stages of the second stage?

A

Passive stage: full dilation until head reaches pelvic floor and the woman experiences the need to push.

Active stage: Pushing with contractions. Typically 40mins primips and 20mins multips.

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13
Q

What is normal blood loss in the third stage?

A

500ml.

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14
Q

What are the main causes of fetal damage during labour?

A

Hypoxia.

Infection / inflammation e.g. GBS.

Meconium aspiration.

Trauma due to interventions

Fetal blood loss.

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15
Q

What is the best indicator of fetal hypoxia?

A

Capillary (fetal scalp) blood, pH <7.2.

In reality, neurological damage only occurs <7.0.

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16
Q

What are the risk factors for fetal distress?

A

Intra-partum: Long labour, meconium, epidural analgesia, oxytocin.

Antepartum: Pre-eclampsia, IUGR.

17
Q

How do you diagnose fetal distress?

A

Meconium staining (pea-soup).

FHR every 15 mins.

CTG.

Fetal blood sampling.

18
Q

How do you assess a CTG?

A

Dr C Bravado!

Dr: define risk - any other risk factors?

C: Contractions: how many in 10 mins? (hyperstimulation = >5)

BR: baseline rate - should be 110-160. Tachycardias indicate infection / fever. Steep, sustained deterioration in rate suggests distress.

V: Variability - short term variability should be >5 bpm, unless fetus is asleep. Prolonged reduced variability suggests hypoxia.

A: Accelerations with movement and contractions are reassuring.

D: Decelerations. Early are synchronous with contractions and benign. Variable reflect cord compression (can cause hypoxia). Late persist after contraction and suggest hypoxia.

O: Overall assessment.

CTGs are good for reassurance, but not great for diagnosis. Confirm hypoxia with fetal scalp pH.

19
Q

What pain relief is used in labour?

A

TENS.

Entonox.

Opiates (pethidine).

Epidural.

20
Q

What are the complications of opiates in pregnancy?

A

Maternal: Sedation, confusion, feeling out of control. Usually require anti-emetics.

Neonatal: Respiratory depression (use naloxone to reverse).

21
Q

What are the effects of an epidural anaesthesia?

A

Complete sensory nerve block with partial motor block.

22
Q

What are the advantages and disadvantages of an epidural?

A

+: Only method to be pain-free, Reduces BP, abolishes premature urge to push, good for converting to C-S.

-: Increased supervision required, immobility causes bed sores, reduced bladder sensation causes urinary retention, maternal fever more common.

23
Q

How do you manage fetal distress?

A

Oxygen, IV fluids, left lateral position, stop oxytocin.

If abnormality persistent, take fetal blood sample.

If fetal distress, C-S.

24
Q

How do you measure progress of labour?

A

1) Dilation.
2) Station of head (+- relative to ischial spines).

25
Q

How long after beginning pushing should you convert to instrumental?

A

1h if no progress.

26
Q

What is the definition of retained placenta?

A

Third stage longer than 30mins.

27
Q

How is managed third stage performed?

A

Oxytocin IM given once shoulders delivered.

Once cord starts to lengthen (i.e. placenta is separating), apply continuous gentle traction with one hand pushing down suprapubically to prevent inversion.

Check placenta for missing pieces and check for tears.

28
Q

What are the grades of tear after delivery?

A

1st degree: skin only.

2nd degree: skin and pelvic floor.

3rd degree: involves anal sphincter.

4th degree: involves anal mucosa.

29
Q

How can labour be artifically initiated?

A

Prostaglandins to ripen the cervix. Can repeat after 6h.

Artificial rupture of membranes.

Oxytocin to initiate contractions.

Natural induction by cervical sweeping.

30
Q

What are the indications for induction?

A

Fetal: prolonged pregnancy, IUGR, fetal compromise, APH, PROM.

Materno-fetal: pre-eclampsia, DM.

Maternal: social, in utero death.

31
Q

What are the complications of induction of labour?

A

Failure of induction.

Hyperstimulation of uterus.

Higher instrumental / C-S risk.

Umbilical cord prolapse.

PPH.

Infection.

Prematurity.

32
Q

What are the contraindications to VBAC?

A

Vertical uterine scar.

Multiple previous C-S.

33
Q

What is the success rate of VBAC?

A

60-80%

34
Q

What are the prerequisites for instrumental vaginal delivery?

A

Head must not be palpable abdominally.

Head must be at or below the level of the ischial spines..

The cervix must be fully dilated.

The position of the head must be known.

There must be adequate analgesia.

The bladder should be empty.

Must be a valid reason!

35
Q

What are the indications for emergency C-S?

A

Prolonged first stage of labour (not dilated after 12h).

Fetal distress.

36
Q

What are the indications for elective caesarean?

A

Absolute: placenta praevia, severe fetal compromise, uncorrectable abnormal lie, previous vertical C-S, gross pelvic deformity.

Relative: breech, severe IUGR, twins, DM, previous C-S, older nulliparous PT, delivery required before 34wks.

37
Q

What are the complications of C-S?

A

Maternal: Infection, bleeding, need for blood transfusion, visceral damage, VTE.

Fetal: fetal respiratory morbidity, fetal lacerations, bonding and breastfeeding affected.

Y5 - Obstetrics & Gynaecology (28 decks)

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