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Gynaecology AMK > Labour and delivery > Flashcards

Labour and delivery Flashcards

1
Q

what is the first stage of labour

A

onset of labour true contractions until cervix is fully dilated to 10cm.
latent,active and transition

Braxton hicks contractions -durign 2nd and 3rd stage of labour - false contraction

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2
Q

2nd stage of labour

A

10cm cervical dilation until delivery of baby

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3
Q

3rd stage of labor

A

from delivery of baby to delivery of the placenta

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4
Q

PROM means

A

the amintioc sac has ruptures before the onset of labour

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5
Q

extreme preterm

A

under 28 weeks

very is 28 -32

moderate to late 32-37

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6
Q

prophylaxis of preterm labour what can you do too prolong labour

A

vaginal progesterone - maintaining pregnancy and preventing labour by decreasing action of myometrium and prevent cervical moderation

cervical cerclage - stitch in cervix to add support to keep closed involving anaesthetic removed when in labour

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7
Q

doubt of amintioc fluid rupture what tests

A

Insulin-like growth factor-binding protein-1 (IGFBP-1) is a protein present in high concentrations in amniotic fluid, which can be tested on vaginal fluid if there is doubt about rupture of membranes
Placental alpha-microglobin-1 (PAMG-1) is a similar alternative to IGFBP-1

prophalcic antiobitcs given to prevent chorioamnionitis

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8
Q

when do you give antenatal steroids

A

Giving the mother corticosteroids helps to develop the fetal lungs and reduce respiratory distress syndrome after delivery. They are used in women with suspected preterm labour of babies less than 36 weeks gestation.

An example regime would be two doses of intramuscular betamethasone, 24 hours apart.

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9
Q

what can you give to protect the brain during fatal delivery if premature.

This reduces the risk of cerebral palsy and severity. given within 24hr of delivery

A

IV magnesium sulfate

what magnesium toxicity

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10
Q

signs of magnesium toxicity

A

Reduced respiratory rate
Reduced blood pressure
Absent reflexes

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11
Q 
Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death
A

indications of when to start labour

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12
Q

what is the bishops score

A

The Bishop score is a scoring system used to determine whether to induce labour.]

A score of 8 or more predicts a successful induction of labour. A score below this suggests cervical ripening may be required to prepare the cervix.

used to monitor along with CTG

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13
Q

how do you induce labour

A

membrane sweep
vagianl PGE2
cervical ripening balloon
oral mifepristone ) anti-progesterone plus misprostol induced labour where fatal death intrauterine has occurred

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14
Q

CTG accelerations and deceerlaerations

A

Accelerations are generally a good sign that the fetus is healthy, particularly when occurring alongside contractions of the uterus.
Decelerations are a more concerning finding. The fetal heart rate drops in response to hypoxia. The fetal heart rate is slowing to conserve oxygen for the vital organs.

DR – Define Risk (define the risk based on the individual woman and pregnancy before assessing the CTG)
C – Contractions
BRa – Baseline Rate
V – Variability
A – Accelerations
D – Decelerations
O – Overall impression (given an overall impression of the CTG and clinical picture)

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15
Q

Progress in labour is influenced by the three P’s:

A

Power (uterine contractions)
Passenger (size, presentation and position of the baby)
Passage (the shape and size of the pelvis and soft tissues)

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16
Q

are NSAIDS avoided in pregnancy

A

yes

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17
Q

simple analgesia in preg

A

paracetamol

other methods include entonox( nitrous oxide and oxygen) , diamorphen (opiod) , remifentanil patietn given , epidural

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18
Q

what is cord prolapse

A

Cord prolapse is when the umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina, after rupture of the fetal membranes. There is a significant danger of the presenting part compressing the cord, resulting in fetal hypoxia.

transverse or oblique lie past 37 weeks

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19
Q

mangamnt of cord prolapse

A

emergency c section

women lie in left lateral position, knee chest position , tocolytic medication such as terbutaline used to minimise contractions whilst waiting fro c section

20
Q

what is shoulder dystocia

A

Shoulder dystocia is when the anterior shoulder of the baby becomes stuck behind the pubic symphysis of the pelvis, after the head has been delivered. This requires additional obstetric manoeuvres to enable delivery of the rest of the body. Shoulder dystocia is an obstetric emergency.

21
Q

main cause of shoulder dystocia

common presentation of head and signs

A

macrosomia secondary to gestational diabetes.

face downwards (occipito-anterior

turtle neck sign

22
Q

what is mcroberts manoeuvre

A

hyeprflexion of mother at the hip knees to abdomen provides psotieor pelvic tilt lifting the PS out the way in shoulder dystocia

Rubins manoeuvre involves reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis.

Wood’s screw manoeuvre is performed during a Rubins manoeuvre. The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery. If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.

Zavanelli manoeuver involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.

23
Q

4 main complications of shoulder dystocia

A

Fetal hypoxia (and subsequent cerebral palsy)
Brachial plexus injury and Erb’s palsy
Perineal tears
Postpartum haemorrhage

24
Q

a single dose of what is recommended after instrumental delivery to reduce the risk of maternal infection

A

co-amoxiclav

25
Q

indications for instrumental delivery

A

Failure to progress
Fetal distress
Maternal exhaustion
Control of the head in various fetal positions

26
Q

main complication of ventouse

A

cephalohaematoma.

27
Q

nerves injured in instrumental delivery

A

femoral and obturator nerve
lateral cuanoeus nerve
lumbosarcal plexus
common perineal nerve

28
Q

when does a perineal tear occur

A

A perineal tear occurs where the external vaginal opening is too narrow to accommodate the baby. This leads to the skin and tissues in that area tearing as the baby’s head passes.

Perineal tears are more common with:

First births (nulliparity)
Large babies (over 4kg)
Shoulder dystocia
Asian ethnicity
Occipito-posterior position
Instrumental deliveries
29
Q

third stage of labour wither physiological management mother does it or achieve managemten with what

A

IM oxytocin and cord clamped and cut within 5 minutes of birth

30
Q

classification of post part haemorrhage

A

t can be classified as:

Minor PPH – under 1000ml blood loss
Major PPH – over 1000ml blood loss

Major PPH can be further sub-classified as:

Moderate PPH – 1000 – 2000ml blood loss
Severe PPH – over 2000ml blood loss

It can also be categorised as:

Primary PPH: bleeding within 24 hours of birth
Secondary PPH: from 24 hours to 12 weeks after birth

31
Q

causes of PPH

A

T – Tone (uterine atony – the most common cause)
T – Trauma (e.g. perineal tear)
T – Tissue (retained placenta)
T – Thrombin (bleeding disorder)

32
Q

preventative measure ofPPH

A

Treating anaemia during the antenatal period
Giving birth with an empty bladder (a full bladder reduces uterine contraction)
Active management of the third stage (with intramuscular oxytocin in the third stage)
Intravenous tranexamic acid can be used during caesarean section (in the third stage) in higher-risk patients

33
Q

The most commonly used skin incision for c section. is a transverse lower uterine segment incision. There are two possible incisions:

Pfannenstiel incision is a curved incision two fingers width above the pubic symphysis
Joel-cohen incision is a straight incision that is slightly higher (this is the recommended incision)

what are the layers that need to be dissected

A

Skin
Subcutaneous tissue
Fascia / rectus sheath (the aponeurosis of the transversus abdominis and external and internal oblique muscles)
Rectus abdominis muscles (separated vertically)
Peritoneum
Vesicouterine peritoneum (and bladder) – the bladder is separated from the uterus with a bladder flap
Uterus (perimetrium, myometrium and endometrium)
amntioci sac

There is a risk of aspiration pneumonitis during caesarean section, caused by acid reflux and aspiration during the prolonged period lying flat. H2 receptor antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) are given before the procedure to reduce the risk of this happening.

34
Q

Venous Thromboembolism

Having a caesarean section is likely to lead to a period of reduced mobility. Women should have a VTE risk assessment performed to determine the type and duration of VTE prophylaxis (follow local guidelines). Prophylaxis for VTE involves:

Early mobilisation
Anti-embolism stockings or intermittent pneumatic compression of the legs
Low molecular weight heparin (e.g. enoxaparin)

A

contradinidcatd for c section

35
Q

Two key causes of sepsis in pregnancy are:

A

Chorioamnionitis

Urinary tract infections

36
Q

All patients admitted to maternity inpatient units, such as at the antenatal ward and labour ward, will have monitoring on a MEOWS chart. MEOWS stands for

A

maternity early obstetric warning system

The non-specific signs of sepsis include:

Fever
Tachycardia
Raised respiratory rate (often an early sign)
Reduced oxygen saturations
Low blood pressure
Altered consciousness
Reduced urine output
Raised white blood cells on a full blood count
Evidence of fetal compromise on a CTG

Additional signs and symptoms related to chorioamnionitis include:

Abdominal pain
Uterine tenderness
Vaginal discharge

Additional signs and symptoms related to a urinary tract infection include:

Dysuria
Urinary frequency
Suprapubic pain or discomfort
Renal angle pain (with pyelonephritis)
Vomiting (with pyelonephritis)
37
Q

amniotic fluid embolism

A

amniotic fluid passes into the mother’s blood.
The amniotic fluid contains fetal tissue, causing an immune reaction from the mother. This immune reaction to cells from the foetus leads to a systemic illne

38
Q

risk factors for amniotic fluid embolism

A

Increasing maternal age
Induction of labour
Caesarean section
Multiple pregnancy

39
Q

symptoms of amniotic fluid syndrome

A 
Shortness of breath
Hypoxia
Hypotension
Coagulopathy
Haemorrhage
Tachycardia
Confusion
Seizures
Cardiac arrest

A – Airway: Secure the airway
B – Breathing: Provide oxygen for hypoxia
C – Circulation: IV fluids to treat hypotension and blood transfusion in haemorrhage
D – Disability: Treat seizures and consider other neurological deficits
E – Exposure

40
Q

uterine rupture is what layer

A

myometrium

Uterine rupture leads to significant bleeding. The baby may be released from the uterus into the peritoneal cavity. It has a high morbidity and mortality for both the baby and mother.

41
Q

The main risk factor for uterine rupture is a

A

previous c section

42
Q

symptoms of uterine rupture

A 
Abdominal pain
Vaginal bleeding
Ceasing of uterine contractions
Hypotension
Tachycardia
Collapse

main one Is cease of uterine contractions

43
Q

mamagement for uterien rutprue

A

emergency c section

44
Q

uterine inversion

A

fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out.

Uterine inversion typically presents with a large postpartum haemorrhage. There may be maternal shock or collapse.

45
Q

management of uterine inversion

A

There are three options for treating uterine inversion:

Johnson manoeuvre
Hydrostatic methods
Surgery

Initial management of an inverted uterus is with the Johnson manoeuvre, which involves using a hand to push the fundus back up into the abdomen and the correct position. It is held in place for several minutes, and medications are used to create a uterine contraction (i.e. oxytocin). The ligaments and uterus need to generate enough tension to remain in place.

Where the Johnson manoeuvre fails, hydrostatic methods can be used. This involves filling the vagina with fluid to “inflate” the uterus back to the normal position. It requires a tight seal

Where both non-surgical methods fail, surgery is required. A laparotomy is performed (opening the abdomen) and the uterus is returned to the normal position.
For example, they may require resuscitation, treatment of postpartum haemorrhage and blood transfusion.

Gynaecology AMK (10 decks)

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