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Repro > Labour > Flashcards

Labour Flashcards

1
Q

What is a birth plan?

A

Record of what woman would like to happen during labour and after birth.

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2
Q

What factors must be considered when making a birth plan?

A

PMH
Circumstances
Services available in area
ICE

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3
Q

What are the hormonal influences on the initiation of labour?

A

Change in oestregen:progesterone ratio (increase oestrogen)
Foetal adrenals and pituitary hormones (oxytocin)
Foetal cortisol

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4
Q

What are the physical influences on the initiation of labour?

A

Myometrial stretch increases excitability of myometria fibres
Mechanical stretch of cervix and stripping of foetal membranes
Ferguson’s Reflex
Pulmonary surfactant secretion into amniotic fluid

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5
Q

What is Ferguson’s Reflex?

A

Neuroendocrine reflex by which contractions are sustained by pressure of cervix/vaginal walls

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6
Q

How does oxytocin influence initiation of labour?

A

initiates and sustains contractions, and promotes prostaglandin release at decidual tissue

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7
Q

What is the function of liquor?

A

Nurture and protect foetus

Facilitates movement

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8
Q

When does rupture of membranes occur?

A 
Can occur: 
Preterm 
Pre-labour (typical)
First stage (typical0
Second stage 
Born in caul
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9
Q

What two cervical changes occur during labour?

A

Softening

Ripening

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10
Q

What happens during cervical softening?

A

Increased hyaluronic acid gives increase in molecules amongst collagen fibres, decreasing bridging and therefore decreasing firmness

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11
Q

What happens during cervical ripening? (x4)

A

Decrease collagen fibre alignment
Decrease collagen fibre strength
Decrease tensile strength of cervical matrix
Increase in cervical decorin (dermatan sulphate proteoglycan 2)

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12
Q

What does the Bishop’s Score measure?

A 
If it is safe to induce labour, via: 
Cervical position 
Cervical consistency 
Effacement dilatation 
Station in pelvis
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13
Q

What are the two phases of first stage of labour, and what characterises these?

A

Latent (3-4cm dilatation)

Active (4-10cm dilatation)

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14
Q

What cm is full dilatation?

A

10cm

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15
Q

What is the normal length of the second stage of labour?

A

Nulliparous - 3 hours with epidural, 2 hours without

Multiparous - 2 hours with epidural, 1 hour without

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16
Q

How long does the third stage of labour normally last?

A

Average - 10 mins

Range - 3 mins - 1 hour

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17
Q

What is first line active management for removal of placenta/membranes?

A

Oxytocin and controlled cord traction

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18
Q

What are Braxton Hicks?

A

False labour contractions - tightening of uterine muscles, do not increase in frequency or intensity
Resolve with ambulation or change in activity

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19
Q

What is the hormonal stimulant for labour contractions?

A

Oxytocin

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20
Q

How do contractions physically expel the foetus?

A

Tighten at the fundus to push baby into the birth canal

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21
Q

How are true labour contractions characterised?

Frequency, duration, intensity

A

Fundal dominance
Regular pattern
Frequency increasing
Duration initially 10-15 sec, builds up to 45
Intensity - increasing over time (mild -> moderate -> strong)

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22
Q

What are the three key factors for smooth progression of labour?

A

Power of contractions
Maternal Pelvis
Foetal factors

(3Ps: Power, Passage, Passenger)

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23
Q

Where in the uterus is the density of smooth muscle myocytes the greatest?

A

Fundus

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24
Q

Where is the uterine pacemaker located?

A

Tubal ostia (bilateral)

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25
Q

How does uterine polarity aid labour?

A

Upper segments of uterus contract and retract, while lower segments and cervix stretch, dilate and relax
Pushes baby downwards into birth canal.

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26
Q

What are the three types of pelvis, and which is the most preferable?

A

Anthropoid
Gynaecoid - most preferable
Android

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27
Q

What are the characteristics of an anthropoid pelvis?

A

Oval shaped inlet, large AP diameter, smaller transverse diameter

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28
Q

What are the characteristics of an android pelvis?

A

Triangular or heart shaped inlet (narrower at front)

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29
Q

African-Caribbean women are of higher risk of Anthropoid pelvic - true/false.?

A

False - they are at higher risk of Android pelvis

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30
Q

What 5 cervical factors influence onset of labour?

A 
Effacement 
Dilatation 
Firmness 
Position 
Level of presenting part/station
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31
Q

What is the normal foetal position for labour?

A

Longitudinal lie
Cephalic presentation
Vertex presenting
Occipito-anterior or occipito-transverse

32
Q

What are the abnormal foetal positions for labour? (x4)

A

Breech position
Oblique lie
Transverse lie
Occipito-posterior position

33
Q

What during vaginal examination determines the foetal position?

A

Position of fontanelles

34
Q

What is a partogram?

A

Graphic record of key maternal and foetal data, contained on one sheet, used to assess the progress of labour

35
Q

What are the 7 cardinal movements of the baby’s head in labour?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Crowning and extension
  6. Restitution and external rotation
  7. Expulsion (anterior shoulder first)
36
Q

What is the purpose of an episiotomy during crowning?

A

Prevent damage to anal sphincters

37
Q

What is crowning?

A

The largest diameter of the head is encircled by the vulval ring

38
Q

Cord clamping should be performed immediately following birth - T/F?

A

False - delayed cord clamping has shown better red blood cell flow to vital organs, less anaemia and increased duration of early breastfeeding

39
Q

What are the benefits of skin-to-skin following labour, and what are the current guidelines for time?

A

Keeps baby warm and calm
Improves transition to life outside the womb
Improves longitudinal breastfeeding

guidelines = ~1 hour uninterrupted

40
Q

When does third stage of labour usually occur?

A

5-10 minutes after delivery (normal < 30 mins)

41
Q

At what plane does placental separation occur?

A

Spongy layer of decidua basalis

42
Q

What are the two types of placental separation, and what is the mechanism of each? (x2)

A

Matthew Duncan - starts at the periphery (most common)

Shultz - starts at central aspect

43
Q

What is the standard active management during third stage of labour?

A

Prophylactic Syntometerine (ergometrine + oxytocin)
Cord clamping and cutting
Controlled cord traction
Bladder emptying

44
Q

What volume of blood loss is considered normal during labour?

A

< 500 mls

45
Q

What physiological mechanisms maintain haemostasis during labour?

A

Tonic contraction (lattice pattern of uterine muscles strangulates the vessels)
Thrombosis of torn vessel ends (hypercoagulable state)
Myo-tamponade opposition of anterior/posterior walls

46
Q

What is puerperium, and how long does it normally last?

A

Period of repair and recovery

~6 weeks

47
Q

What is Lochia?

A

vaginal discharge containing blood mucus, and endometrial castings lasing ~2 weeks after birth

48
Q

What are the three types of lochia, and what is the usual timeline for each?

A

Rubra (fresh red blood) 3-4 days
Serosa (brownish and watery) 4-14 days
Alba (yellow) 10-20 days

49
Q

What uterine changes occur following birth?

A

Involution
Reduction in weight
Fundal height
Endometrial regeneration

50
Q

How is lactation initiated following labour?

A

Placental expulsion + decrease in Oestrogen and Progesterone

O+P inhibit prolactin release so reduction in these allows for prolactin to activate mammary gland cells

51
Q

What component of breast milk contains important immunological effects for baby?

A

Colostrum

52
Q

What are the 7 reasons for abnormal labour?

A
  1. Too early (<37 weeks)
  2. Too late (induction at >42 weeks)
  3. Too painful (requires anaesthetist)
  4. Too long (failure to progress)
  5. Too quick (hyperstimulation)
  6. Foteal concerns e.g. hypoxia, sepsis
  7. Incorrect presentation
53
Q

Which type of breech is characterised by both legs folded up with the feet at the level of the baby’s bum?

A

Complete breech

54
Q

Which type of breech is characterised by one or both feel pointing downwards?

A

Footling

55
Q

Which type of breech are the legs pointing upwards (so bum emerges first)?

A

Frank (most common)

56
Q

What are the complications of transverse presentation?

A 
Prolonged labour 
Rupture 
Maternal death (rare in UK)
57
Q

What are the side effects of epidural anaesthesia?

A 
Hypotension 
Dural puncture 
Headache 
High block 
Atonic bladder 
Reduced mobility 
Prolonged second stage of labour - increased chance of operative birth
58
Q

At what level is the epidural injected into?

A

Between L3 and L4

59
Q

What are the risks of obstruction to labour?

A 
Sepsis 
Uterine rupture 
Obstructed AKI 
Postpartum haemorrhage 
Fistula formation 
Foetal asphyxia 
Neonatal sepsis
60
Q

What are signs of obstruction of labour?

A 
Moulding 
Caput 
Anuria 
Haematuria 
Vulval Oedema
61
Q

What are the average dimensions of the pelvic inlet and outlet?

A

Inlet - 13.5cm x 11cm

Outlet - 11cm x 13.5cm

62
Q

Which presentation most commonly causes slow progress in labour?

A

Occipito-posterior (OP)

63
Q

What intrapartum foetal assessments for hypoxia are made?

A

Doppler auscultation
Electronic monitoring (CTG)
Colour of amniotic fluid

64
Q

What are the risk factors for foetal hypoxia?

A 
Small foetus 
Pre-term/post dates 
Antepartum haemorrage 
HTN/pre-eclampsia 
Diabetes 
Meconium 
Epidural 
VBAC 
PROM > 24 hours 
Sepsis 
Induction of labour
65
Q

Presence of any one RF for foetal hypoxia is indicative for…

A

continuous foetal heart monitoring

66
Q

What are acute causes of foetal hypoxia?

A 
Uterine hyperstimulation 
Abruption 
Cord prolapse 
Uterine rupture 
Foeto-maternal haemorrhage 
Regional anaesthesia 
Vasa Praevia
67
Q

What are chronic causes of foetal hypoxia?

A

Placental insufficiency

Foetal anaemia

68
Q

How do you interpret CTG?

hint - pneumonia

A

DR C BRAVADO

Determine Risk 
Contractions 
Baseline 
RAte 
Variability 
Accelerations 
Decelerations 
Overall impression
69
Q

What management is considered following abnormal CTG?

A 
Change maternal positon 
IV fluids 
Stop syntocinon 
Scalp stimulation 
Consider Tocolysis with Terbutaline 
Maternal assessment 
Consider foetal blood sampling
70
Q

What is considered normal and abnormal for scalp pH, and what is the action taken for this?

A

Normal - > 7.25 - no action
Borderline 7.20-7.25 - repeat 30 mins
Abnormal - < 7.2 - delivery

71
Q

What are the standard indications for an operative vaginal delivery?

A

Failure to progress in stage 2 for:
Prims - 2 hours no epidural, 3 hours with
Multips - 1 hour no epidural, 2 hours with

72
Q

What are special indications for operative vaginal delivery?

A

Maternal cardiac disease
Severe PET/eclampsia
Intrapartum haemorrhage
Umbilical cord prolapse during stage 2

73
Q

How is the most appropriate instrument chosen for operative vaginal delivery?

A

Agpar score

74
Q

What are the benefits and risks to Ventouse?

A

Benefits - reduced anaesthesia, vaginal traum and perineal pain

Increased - failure, cephalohaematoma, retinal haemorrhage and maternal worry

75
Q

What are the indications for caesarean section?

A 
Previous CS 
Foetal distress 
Failure to progress 
Breech presentation 
Maternal request

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