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Obs and Gynae > Labour > Flashcards

Labour Flashcards

1
Q

Define labour

A

onset of uterine contractions increasing strength and duration, dilatation and effacement of cervix, expulsion of baby

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2
Q

How does the baby move after it starts its descent?

A

flexion, internal rotation, extension, external rotation (restitution)

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3
Q

How much does the cervix dilate by in the latent first stage of labour?

A

3-4cm

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4
Q

How do you know when youre in the active 1st stage of labour?

A

4 contractions in 10 minutes dilating 1.5cm and hour in parous women and 1cm an hour in primigravid

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5
Q

What happens in the second stage of labour?

A

Baby is delivered

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6
Q

3rd stage of labour?

A

Placenta delivered

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7
Q

What ‘attitude’ would you expect to see in normal early labour?

A

flexed head

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8
Q

Different lies of the fetus?

A

Longitudinal, transverse, oblique

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9
Q

Different types of presentation of the fetus?

A

cephalic, breached, shoulder presentation with transverse lie,

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10
Q

What is the point of reference?

A

point on the presenting part used to orientate it to the maternal pelvis - occiput, mentum, sacrum

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11
Q

what is position? what is it usually in reference to?

A

Relation of the point of reference to one of the 8 octanes of the pelvic inlet - occiput usually

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12
Q

Engagement?

A

BPD is at the inlet of the true pelvis

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13
Q

Station?

A

Presenting part to the level of the ischial spines measured in plus or minus cm S+2

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14
Q

Effacement?

A

Shortening of the cervix until it starts to become dilated

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15
Q

3 Ps of labour

A

power, passenger, passages

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16
Q

What is the usual position of the point of reference?

A

occiput anterior

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17
Q

Why does woman puff in second stage of labour?

A

Reduce sudden movements and tears

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18
Q

What direction is an episiotomy cut?

A

Right mediolateral direction away from anal sphincter

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19
Q

What synthetic oxytocin is given?

A

syntometrine IM

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20
Q

How would you overcome dystocia in terms of powers of contractions?

A

artificial rupture of membranes, IV Syntocinon, empty bladder, fluids, analgesia, forceps, vacuum extraction

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21
Q

How can you aid in malposition of a baby in the 1st and 2nd trimester to move it into OA

A

increase uterine contractions

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22
Q

DIfference between positional cephalopelvic disproportion and absolute cephalopelvic disproportion

A

Positional is due to the way the baby is lying and absolute is due to the size of the baby

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23
Q

2 common presenting features of cephalopelvic disproportion

A

Caput - swelling of head, moulding - overlapping sutures

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24
Q

3 main reasons for C-section

A

Cephalopelvic disproportion, Emergency, elective

25
Q

Measuring fetal HR in low risk vs high risk labours?

A

low risk with pinnard and doppler, high risk with CTG

26
Q

If there is an abnormal fetal HR what is performed?

A

Scalp blood test for pH

27
Q

TENS?

A

electrical neurostimulation on the back usually during latent stage

28
Q

What is the name for the gas and air?

A

Entonox

29
Q

What opioids can be given in labour?

A

Pethidine, remifentanil

30
Q

What receptors does entonox work at?

A

NMDA spinal receptors

31
Q

What can prolonged exposure to entonox potentially increase the risk of?

A

Folate metabolism and future miscarriage

32
Q

What does TENS stand for?

A

transcutaneous electrical nerve stimulation

33
Q

Where are the 4 electrodes placed in TENS?

A

2 at lumbar 2 at sacral

34
Q

Opioids given in labour?

A

Pethidine, diamorphine, remifentanil, (meptazinal, nalbuphine, fentanyl)

35
Q

What dose of pethidine do you administer?

A

50-100mg IM

36
Q

How long does pethidine take to work?

A

20 minutes

37
Q

What receptors do pethidine work on?

A

mu opioid receptors

38
Q

How is remifentanil administered?

A

patient controlled pump pressed as contractions start

39
Q

What is the benefit of using remifentanil?

A

Doesn’t accumilate as ultra short acting

40
Q

How is diamorphine administered?

A

SC or IV

41
Q

What drug is found within an epidural?

A

Fentanyl

42
Q

How much oral codeine can be given before labour?

A

60mg

43
Q

What are the side effects of an epidural?

A

Hypotension, catheter due to loss of bladder control, post dural puncture headache, inadequate analgesia, itch, motor block, fever

44
Q

What is the drug dinoprostone used for?

A

Prostaglandin vaginal preparations to induce labour

45
Q

Define induction of labour

A

Stimulation of regular uterine contractions after spontaneous onset of labour

46
Q

What is the scoring system involving the cervix to work out whether induction of labour is needed?

A

Bishops score - dilatation, length, station, consistency, position

47
Q

Contraindications to epidural

A

Maternal coagulopathy, ongoing haemorrhage, refusal, septicaemia

48
Q

When is it classified as poor progress in labour?

A

less than 2cm dilation in 4 hours

49
Q

Ideally how many contractions do you want in 10 minutes?

A

3-4 in 10 minutes lasting 40 seconds

50
Q

In uterine hyperstimulation what is the risk and how is it prevented?

A

Decreased fetal perfusion, lie the woman laterally, stop drip, give tocolysis terbutaline and IV fluids

51
Q

The ADH effect of oxytocin can lead to what side effect?

A

Hyponatraemia

52
Q

Types of forceps

A

Barnes-Neville non rotational forceps, Kielland’s rotational forceps, Wrigley’s lift out forceps

53
Q

What antibiotics are given during and after operation for anal sphincter repair?

A

Cefuroxime and metronidazole

54
Q

When do you follow up a patient who had an anal sphincter repair?

A

6 weeks post op

55
Q

Risk factors for 3rd degree tear?

A

Occipitoposterior, over 4kg, first pregnancy

56
Q

Define a PPH

A

blood loss of over 500mls in 24 hours post delivery

57
Q

the 4 Ts of PPH

A

Trauma - tears, rupture, Tissue - placental tissue still inside, tone - uterine tone still intact, thrombosis - coagulation failure

58
Q

What can predispose to uterine atony?

A

Prolonged labour, IoL, big baby, slow progress, syntocin drip, instrumental, multiparity, infection

59
Q

What medications can you give and what dose/rate to induce contraction of the uterus after delivery?

A

Syntocinon 40IU in 500ml saline over 4 hours, ergometrine 500mcg IV, carboprost 250 mcg every 15 mins IM 8 doses, Misoprostol 800mcg PR

Obs and Gynae (27 decks)

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