Labour Flashcards
Define labour
onset of uterine contractions increasing strength and duration, dilatation and effacement of cervix, expulsion of baby
How does the baby move after it starts its descent?
flexion, internal rotation, extension, external rotation (restitution)
How much does the cervix dilate by in the latent first stage of labour?
3-4cm
How do you know when youre in the active 1st stage of labour?
4 contractions in 10 minutes dilating 1.5cm and hour in parous women and 1cm an hour in primigravid
What happens in the second stage of labour?
Baby is delivered
3rd stage of labour?
Placenta delivered
What ‘attitude’ would you expect to see in normal early labour?
flexed head
Different lies of the fetus?
Longitudinal, transverse, oblique
Different types of presentation of the fetus?
cephalic, breached, shoulder presentation with transverse lie,
What is the point of reference?
point on the presenting part used to orientate it to the maternal pelvis - occiput, mentum, sacrum
what is position? what is it usually in reference to?
Relation of the point of reference to one of the 8 octanes of the pelvic inlet - occiput usually
Engagement?
BPD is at the inlet of the true pelvis
Station?
Presenting part to the level of the ischial spines measured in plus or minus cm S+2
Effacement?
Shortening of the cervix until it starts to become dilated
3 Ps of labour
power, passenger, passages
What is the usual position of the point of reference?
occiput anterior
Why does woman puff in second stage of labour?
Reduce sudden movements and tears
What direction is an episiotomy cut?
Right mediolateral direction away from anal sphincter
What synthetic oxytocin is given?
syntometrine IM
How would you overcome dystocia in terms of powers of contractions?
artificial rupture of membranes, IV Syntocinon, empty bladder, fluids, analgesia, forceps, vacuum extraction
How can you aid in malposition of a baby in the 1st and 2nd trimester to move it into OA
increase uterine contractions
DIfference between positional cephalopelvic disproportion and absolute cephalopelvic disproportion
Positional is due to the way the baby is lying and absolute is due to the size of the baby
2 common presenting features of cephalopelvic disproportion
Caput - swelling of head, moulding - overlapping sutures
3 main reasons for C-section
Cephalopelvic disproportion, Emergency, elective
Measuring fetal HR in low risk vs high risk labours?
low risk with pinnard and doppler, high risk with CTG
If there is an abnormal fetal HR what is performed?
Scalp blood test for pH
TENS?
electrical neurostimulation on the back usually during latent stage
What is the name for the gas and air?
Entonox
What opioids can be given in labour?
Pethidine, remifentanil
What receptors does entonox work at?
NMDA spinal receptors
What can prolonged exposure to entonox potentially increase the risk of?
Folate metabolism and future miscarriage
What does TENS stand for?
transcutaneous electrical nerve stimulation
Where are the 4 electrodes placed in TENS?
2 at lumbar 2 at sacral
Opioids given in labour?
Pethidine, diamorphine, remifentanil, (meptazinal, nalbuphine, fentanyl)
What dose of pethidine do you administer?
50-100mg IM
How long does pethidine take to work?
20 minutes
What receptors do pethidine work on?
mu opioid receptors
How is remifentanil administered?
patient controlled pump pressed as contractions start
What is the benefit of using remifentanil?
Doesn’t accumilate as ultra short acting
How is diamorphine administered?
SC or IV
What drug is found within an epidural?
Fentanyl
How much oral codeine can be given before labour?
60mg
What are the side effects of an epidural?
Hypotension, catheter due to loss of bladder control, post dural puncture headache, inadequate analgesia, itch, motor block, fever
What is the drug dinoprostone used for?
Prostaglandin vaginal preparations to induce labour
Define induction of labour
Stimulation of regular uterine contractions after spontaneous onset of labour
What is the scoring system involving the cervix to work out whether induction of labour is needed?
Bishops score - dilatation, length, station, consistency, position
Contraindications to epidural
Maternal coagulopathy, ongoing haemorrhage, refusal, septicaemia
When is it classified as poor progress in labour?
less than 2cm dilation in 4 hours
Ideally how many contractions do you want in 10 minutes?
3-4 in 10 minutes lasting 40 seconds
In uterine hyperstimulation what is the risk and how is it prevented?
Decreased fetal perfusion, lie the woman laterally, stop drip, give tocolysis terbutaline and IV fluids
The ADH effect of oxytocin can lead to what side effect?
Hyponatraemia
Types of forceps
Barnes-Neville non rotational forceps, Kielland’s rotational forceps, Wrigley’s lift out forceps
What antibiotics are given during and after operation for anal sphincter repair?
Cefuroxime and metronidazole
When do you follow up a patient who had an anal sphincter repair?
6 weeks post op
Risk factors for 3rd degree tear?
Occipitoposterior, over 4kg, first pregnancy
Define a PPH
blood loss of over 500mls in 24 hours post delivery
the 4 Ts of PPH
Trauma - tears, rupture, Tissue - placental tissue still inside, tone - uterine tone still intact, thrombosis - coagulation failure
What can predispose to uterine atony?
Prolonged labour, IoL, big baby, slow progress, syntocin drip, instrumental, multiparity, infection
What medications can you give and what dose/rate to induce contraction of the uterus after delivery?
Syntocinon 40IU in 500ml saline over 4 hours, ergometrine 500mcg IV, carboprost 250 mcg every 15 mins IM 8 doses, Misoprostol 800mcg PR
