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Obstetrics And Gynaecology > Labour And Complications > Flashcards

Labour And Complications Flashcards

1
Q

Roughly how many pregnancies require an induction of labour?

A

One in five

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2
Q

What are the indications for induction of labour?

A 
Prolonged gestation before 42 weeks
Premature rupture of membranes
Maternal health problems
Fetal growth restriction
Intrauterine fetal death
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3
Q

What are the contra indications for induction of labour?

A 
Head to pelvic disproportion
Major placenta previa
Vasa praevia 
Cord prolapse
Transverse lie
Active primary genital herpes
Previous classical cesarian section
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4
Q

What are the three main methods of induction?

A

Vagina prostaglandins
Amniotomy
Membrane sweep

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5
Q

Describe the use of vagina prostaglandins for induction of labour

A

Act to prepare the cervix for labour by ripening it
Also have a role in contraction of the uterus
Gel, tablet or pessary

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6
Q

Describe amniotomy for induction of labour

A

Membranes are ruptured artificially using an instrument called an amnihook
The process releases prostaglandins in an attempt to cause labour, it is only performed when the cervix has been deemed ripe
Often artificial oxytocin will be given alongside to increase the strength and frequency of contractions

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7
Q

When is the membrane sweep offered?

A

40 and 41 weeks to nulliparous women

41 weeks to multiparous women

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8
Q

A bishop score of seven or more suggest what?

A

The cervix is ripe and favourable

High chance of a response to interventions made to induce labour

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9
Q

A bishop score of less than four means what?

A

Suggest that labour is less likely to progress naturally and prostaglandin will be required

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10
Q

What are the complications of induction of labour?

A 
Failure to induce
Uterine hyperstimulation
Cord prolapse
Infection
Pain
Increased rate of further intervention compared to spontaneous labour
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11
Q

How common is an instrumental vaginal delivery?

A

12-13%

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12
Q

What are the indications for performing an instrumental delivery?

A

Inadequate progress
Maternal exhaustion
Maternal medical conditions that mean active pushing should be limited
Suspected foetal compromise

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13
Q

What are the contra indications for an instrumental delivery?

A 
Unengaged fetal head
Incompletely dilated cervix
True head to pelvic disproportion
Breech and face presentations
Pre-term gestation < 34 weeks (ventouse)
High likelihood of fetal coagulation disorder (ventouse)
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14
Q

What are the complications of an instrumental delivery?

A 
Fetal scalp lacerations
Haematoma
Facial nerve damage
Vagina tears
Incontinence
PPH
Infection
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15
Q

Define labour

A

The progressive effacement and dilatation of the cervix in the presence of regular uterine contractions

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16
Q

What is the normal cephalic presentation?

A

Occiput-anterior

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17
Q

What does a station of -1 in labour mean?

A

Widest part of baby’s head is 1cm above the ischial spines

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18
Q

What is the commonest presentation problem with labour?

A

Occipital-posterior

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19
Q

What are the different types of breech?

A

Extended - feet up
Flexed - feet down
Footling

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20
Q

ECV has what chance of causing foetal distress?

A

1 in 100

21
Q

What do you do if foetal bradycardia seen for 3 mins?

A

Call for help

22
Q

What do you do if foetal bradycardia seen for 6 mins?

A

Take to theatre

23
Q

What percentage of VBACs are successful?

A

70-75%

24
Q

What is the chance of uterine rupture in VBAC?

A

1 in 200

25
Q

Why shouldn’t you induce or give oxytocin in VBAC births?

A

Increased risk of uterine rupture

26
Q

What is the management of shoulder dystocia?

A

Call for help
McRobert’s position - knees to chest
Suprapubic pressure
Woodscrew manoeuvre

27
Q

What is Sheehan syndrome?

A

Pan hypopituitarism resulting from massive post-partum haemorrhage causing pituitary ischaemia and necrosis

28
Q

What is the difference between primary and secondary PPH?

A

Primary- first 24 hours

Secondary- >24 hours since birth

29
Q

What management can be used for PPH?

A 
Keep patient laying flat and warm 
IV crystalloids
Blood transfusion 
FFP
Cryoprecipitate and platelets if needed
30
Q

What are the main causes of PPH?

A

Uterine atony
Birth trauma
Retained tissue
Coagulopathy

31
Q

What are the risk factors for PPH?

A 
Placental abruption/praevia
Twins
High BP
Induction
Long labour 
Previous PPH
Anaemia
32
Q

What is the APGAR score used for?

A

To quickly summarise the health of newborn children against infant mortality

33
Q

When is the APGAR score generally done?

A

1 min and 5 mins after birth

34
Q

What is a normal APGAR score?

A

7 +

35
Q

What are the strongest risk factors for post-natal depression?

A

Prior depression or mental health problems
Prior PND
poor social support/relationship with partner
Recent major life events

36
Q

What is the peak onset of PND symptoms?

A

2-3 months post-partum

37
Q

What are the management options for PROM?

A

Expectant
Antibiotics
Steroids
Cervical ripening eg. Induction methods

38
Q

What are the risk factors for PROM?

A 
Previous PROM
Unexplained PV bleed
Abruption
Cervical insufficiency
Smoking 
Polyhydramnios
Infection
Amniocentesis
39
Q

Describe the degrees of perineal tear

A 
1st = injury to perineal skin only 
2nd = involving perineal muscles
3rd = involving anal sphincter complex
4th = involving anal epithelium
40
Q

What factors make VBAC more risky?

A

Last C section <18 months ago

>1 C section

41
Q

What is a normal foetal heart rate?

A

110-160

42
Q

What can cause mild foetal bradycardia?

A

Post-dates
OP
Transverse

43
Q

What causes severe foetal bradycardia?

A 
Prolonged cord compression 
Cord prolapse 
Epidural/spinal
Maternal seizures 
Rapid foetal descent
44
Q

What are the causes of decreased variability on CTG?

A 
Foetal sleeping
Foetal acidosis
Foetal tachycardia 
Drugs
Prematurity
45
Q

Define decelerations on CTG

A

Abrupt decrease in baseline HR >15 bpm for >15 secs

46
Q

What does a late deceleration indicate the presence of?

A

Insufficient blood flow to the placenta

47
Q

When do we define a deceleration as prolonged?

A

> 3 mins

48
Q

How are the hormones involved in breast feeding?

A

Prolactin - milk production

Oxytocin - milk let down

49
Q

What are the advantages of breast feeding?

A 
Babies have fewer infections
Bonding 
Decreased risk breast and ovarian cancer 
Further contractions of uterus
Aids weight loss

Obstetrics And Gynaecology (6 decks)

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