Labour and Birthing Flashcards

1
Q

Normal Labour

A
Occurs spontaneously
37-42 weeks gestation
Singleton
Cephalic presentation
Regular contractions resulting in cervical dilation
No intervention
Can last 4-24hrs
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2
Q

Second Stage

A

Full dilatation to birth of baby
Strong contractions, 2-4mins apart lasting 60-90sec
Full dilation to 10cm
Urge to push
Advancement of the presenting part to birth of the baby
1-2hrs in duration

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3
Q

Third Stage

A

From birth of baby to birth of placenta
Up to 1hr physiologically
Oxytocic is given usually
Estimate blood loss

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4
Q

Pre-labour Rupture of Membranes (PROM)

A

10% of pregnancies
Diagnosis difficult - history, examination and Amnisure
Check for infection
NO VE
Reasonable to induce them the next day or send home and wait up to 96hrs

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5
Q

Pre-term Pre-labour Rupture of Membranes (PPROM)

A

23-36+6 weeks
RF - PHx PPROM, infection, smoking, APH, polyhydramnios, multiple pregnancy
Give antibiotics (erythromycin) and steroids
Wait to at least 34 weeks to deliver if no signs of infection

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6
Q

Pre-viable PPROM

A

<24 weeks
Causes include iatrogenic (amniocentesis) and spontaneous (infection, cervical incompetence, abruption).
Fetal complications include death, severe prematurity, sepsis, pulmonary hypoplasia and skeletal deformities

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7
Q

Pain relief options in labour

and their side effects

A

Non-pharmacological - hot water, massage, positioning, music, rocking, medicine ball
Nitrous oxide gas (S/E: dizziness, dry mouth, nausea)
Pethidine IM (S/E: maternal and fetal sedation, risk of sciatic nerve injury)
Epidural/spinal anaesthetic (S/E: anaesthetist, paralysis, infection, loss of motor function, IV access, catheter, maternal hypotension, increased chance of needing syntocinin)

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8
Q

Indications for Induction of labour

A
Maternal health (DM, PET)
Distressed baby
>41 weeks
PROM
Prolonged first stage (cervix dilating <1cm/hr)
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9
Q

Methods of inducing labour

A

Membrane sweep (can be done at 39-40 weeks)
ARM
Prostaglandins if cervix is unfavourable
Oxytocin if cervix is favourable

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10
Q

Indications for instrumental delivery

A
Maternal exhaustion
Inability to push (e.g. due to epidural)
Prolonged 2nd stage
Fetal distress
Twins - for the second twin
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11
Q

Forceps complications

A

Maternal - injury to vaginal wall, requires episiotomy, fecal incontinence, infection, dyspareuria
Fetal - may leave mark on the babies face however this will fade, facial nerve palsy, cephalhaematoma, subconjunctiva haemorrhage, skull fracture

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12
Q

Forceps requirements

A
Confirmed ROM
Fully dilated cervix
Presenting part below the ischial spines
Adequate analgesia
Empty bladder (catheter)
Cephalic presentation
No obvious cephalic-pelvis disproportion
Position of fetus is known
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13
Q

Ventouse Contraindications

A
Bleeding disorder
Predisposition to fracture (e.g. OI)
Fetal head above ischial spines
Significant prematurity (<34 weeks)
Face presentation
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14
Q

Looking for fetal distress in labour

A

Liquor
Fetal heart rate
CTG
Fetal scalp blood sampling

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