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Block 42 - Women's Health > Labour and Delivery > Flashcards

Labour and Delivery Flashcards

1
Q

Three phases of first stage of labour

A

latent, active, transition

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2
Q

Latent phase of stage 1 of labour

A

0-3cm dilated, painful contractions, may or not be continuous

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3
Q

active phase of stage 1

A

this is between 4 and 7cm dilation. This progresses at 1cm an hour with regular contractions.

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4
Q

Transition phase of stage 1

A
  • this is between 7 and 10cm dilation and progresses at 1cm an hour with strong regular contractions.
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5
Q

Braxton Hicks contractions

A

These are occasional irregular contractions of the uterus. They are usually felt during T2 and T3. Women will experience temporary and irregular cramping / tightening in the abdomen. BH contractions do not indicate labour onset and do not progress or become regular.

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6
Q

4 signs of labour (presentation)

A

Show - mucus plug leaving cervix
Rupture of the membranes aka water breaking
Regular, painful contractions
Dilating cervix on examination

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7
Q

NICE say established first stage of labour is when (2)

A

Regular painful contractions

Dilation of the cervix past 4cm

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8
Q

Rupturing of the membranes is when

A

the amniotic sac ruptures

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9
Q

Spontaneous rupture of membranes is when

A

the amniotic sac ruptures spontaneously

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10
Q

Premature rupture of the membranes is

A

when the amniotic sac ruptures before the onset of labour

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11
Q

Preterm prelabour rupture of the membranes is when

A

the amniotic sac has ruptured before the onset of labour and before 37 weeks gestation

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12
Q

Prolonged rupture of the membranes is when

A

the amniotic sac ruptures more than 18 hours before delivery.

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13
Q

Before which week is a baby considered premature

A

37 weeks

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14
Q

Non viable babies are babies born before

A

23 weeks gestation (10% survival rate). If a baby is born between 23 and 24 resus is not considered if babies show no sign of life.

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15
Q

WHO classification of prematurity

A

<28 weeks is Extreme preterm
28-32 weeks is very preterm
32 -37 is moderate to late preterm

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16
Q

2 forms of prophylaxis for preterm labour

A

vaginal progesterone, cervical cerclage

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17
Q

Vaginal progesterone is given as prophylaxis for preterm (stopping a preterm happening) because

A

progesterone maintains pregnancy / prevents labour by decreasing myometrial activity and inhibiting cervical remodeling.

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18
Q

Who is vaginal progesterone offered to?

A

This is offered to women who have a cervical length of less than 25mm on vaginal ultrasound between 16 and 24 weeks gestation.

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19
Q

What is Cervical cerclage

A

This is putting a stitch in the cervix to add support and keep it closed. It’s done under spinal / GA. The stitch is removed when the woman goes into labour or reaches term.

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20
Q

Who is cervical cerclage offered to?

A

This is offered to women who have a cervical length of less than 25m on vaginal ultrasound between 16 and 24 weeks gestation but also have previous premature birth or cervical trauma (eg colposcopy and cone biopsy)

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21
Q

When can a rescue cervical cerclage be offered

A

between 16 and 27+6 weeks gestation when there is cervical dilation with no rupture of the membranes, this prevents progression to premature delivery.

22
Q

What happens in preterm labour with intact membranes

A

There are regular painful contractions and cervical dilation but no amniotic sac rupture.

23
Q

NICE recommendations for diagnosing preterm labour with intact membrane Less than 30 weeks gestation

A

A clinical assessment alone is enough to offer preterm management

24
Q

NICE recommendations for diagnosing preterm labour with intact membrane more than 30 weeks

A

A transvaginal ultrasound to assess cervical length
When it’s less than 15mm management of preterm can be offered
Cervical length over 15mm indicates preterm is unlikely

25
Q

5 features of Management of preterm

A

Fetal monitoring
Tocolysis with nifedipine
Maternal corticosteroids can be offered before 35 weeks
IV magnesium sulfate can be offered before 34 weeks (protects babies brain)
Delayed cord clamping / cord milking

26
Q

Tocolysis

A

Tocolysis is using medication to stop uterine contractions.

27
Q

Which medication is used in tocolysis

A

Nifedipine is a calcium channel blocker and the medication of choice. If nifedipine is contraindicated (why) then atosiban is an oxytocin blocker that can be used.

28
Q

When can Tocolysis can be used (dates)? and why?

A

between 24 and 33+6 weeks gestation in preterm labour to delay delivery buying time for further fetal development, administration of maternal steroids or to transfer to a more specialist unit (somewhere with an neonatal ICU). tocolysis is only used short term, e.g. for 48 hours.

29
Q

absolute contraindications for tocolysis (3)

A

Chorioamnionitis
Foetal death or lethal abnormality
Maternal or foetal condition requiring immediate delivery

30
Q

Relative contraindications for tocolysis (5)

A 
Foetal growth restriction or distress
Pre-eclampsia
Placenta praevia
Abruption
Cervix >4cm
31
Q

Tocolytics used in caution with

A

in diabetes and multiple pregnancy due to pulmonary oedema risk.

32
Q

Why are antenatal steroids given

A

Giving the mother corticosteroids is done to help develop fetal lungs and to reduce the chance of respiratory distress syndrome post delivery.

33
Q

When are antenatal steroids given

A

less than 36 weeks

34
Q

Antenatal steroids regimen

A

two doses of IM betamethasone 24 hours apart.

35
Q

Why is IV magnesium sulfate given

A

IV magnesium sulfate maternally helps protect the fetal brain during premature rupture delivery. It reduces risk and severity of cerebral palsy.

36
Q

When is IV magnesium sulfate given?

A

It is given within 24 hours of delivery of preterm babies before 34 weeks gestation as a bolus followed by infusion for 24 hours/ until delivery.

37
Q

3 key signs for magnesium toxicity to look out for when mg sulfate given

A

Reduced resp rate
Reduced BP
Absent patellar reflex’

38
Q

2 tests for proteins that are high in amniotic fluid and not in vaginal fluid used to confirm preterm premature rupture

A

Insulin like growth factor binding protein (IGFBP-1)

Placental alpha microglobulin 1 (PAMG-1)

39
Q

Management for preterm premature rupture (4 points)

A

Prophylactic antibiotic to prevent the development of chorioamnionitis
NICE 2019 say give 250mg erythromycin 4x daily for ten days
Or until labour is established if within 10 days
If 34+ weeks then do induction of labour

40
Q

Causes of delays in labour - 3 p’s

A

Power (uterine contractions), passenger (foetal skull), passage (pelvic structure)

41
Q

When is induction of labour offered (weeks)

A

between 41 and 42 weeks of gestation.

42
Q

When is induction of labour offered (complications x6)

A 
Premature rupture of membranes
Fetal growth restriction
Pre eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death
43
Q

When is the bishop score used?

A

when deciding whether labour should be induced or not.

44
Q

Bishop scoring system & values

A 
Fetal station 0-3
Cervical position 0-2
Cervical dilation 0-3
Cervical effacement 0-3
Cervical consistency 0-2
45
Q

What bishop score suggests a successful induction of labour?

A

8+

46
Q

bishop score <8 suggests

A

cervical ripening may be required to prepare the cervix.

47
Q

bishop score > 9

A

labour will likely happen spontaneously

48
Q

bishop score <5

A

indicates labour is unlikely to start without induction

49
Q

5 options for inducing labour

A

Membrane sweep, vaginal prostaglandin E2, cervical ripening balloon, artificial rupture of the membrane, oral mifepristone plus misoprostol

50
Q

4 options when induction doesn’t work initially

A

Further vaginal prostaglandins
Artificial rupture of the membranes and oxytocin infusion
Cervical ripening balloon
Elective c section

Block 42 - Women's Health (4 decks)

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