Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3- Reproduction > Labour and Delivery > Flashcards

Labour and Delivery Flashcards

1
Q

premature labour

A

birth before 37 weeks gestation.

Considered viable from 24 weeks
Extreme preterm: <28 weeks
Very preterm: 28-32 weeks
moderate/late preterm: 32-37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

prophylaxis of preterm labour

A

vaginal progesterone
- decreases activity of myometrium and preventing cervix remodelling

Cervical cerclage
-stitch in cervix to add support and keep it closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

preterm prelabour rupture of membranes

A

amniotic sac rupture, releasing amniotic fluid, before the onset of labour and in a preterm pregnancy

management; prophylactic Abx (erythromycin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

preterm labour with intact membranes

A

regular painful contraction and cervical dilatation without rupture of amniotic sac.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

management of preterm labour with intact membranes

A

Fetal monitoring (CTG)
Tocolysis with Nifedipine
Maternal corticosteroids (<36 weeks gestation)
IV magnesium sulphate (<34 week gestation)
Delayed cord clamping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tcolysis

A

Using medications to stop uterine contractions.

Nifedipine
-CCB: medication of choice for tocolysis

Atosiban if Nifedipine contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

breech presentation (+types)

A

presenting part of foetus is legs and bottom

Complete
-legs fully flexed at hips and knees

Incomplete
- one leg flexed at hip and extended at knee

Extended breech

  • Frank breech
  • Both legs flexed at hip and extended at knee

Footling breech
- foot presenting through cervix with leg extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

management of breech

A

before 36 weeks
- often turn spontaneously: no breech required

External Cephalic Version

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

active management of third stage

A

physiological management

Active management
- dose of intramuscular oxytocin to help uterus contract & careful traction to umbilical cord to guide placenta out of uterus & vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

amniotic fluid embolism

A

Rare
Amniotic fluid passes into mother’s blood.
usually occurs around labour and delivery.
Amniotic fluid contains foetal tissue, causing immune reaction from the mother.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

presentation of amniotic fluid embolism

A 
SOB
hypoxia
hypotension 
coagulopathy
haemorrhage
tachycardia 
confusion 
seizures
cardiac arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

management of amniotic fluid embolism

A

supportive

ABCDE approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

c-section most common skin incision

A

transverse lower uterine segment incision

Blunt dissection is used after initial incision with scalpel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cord prolapse

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cord prolapse risk factor

A

Abnormal lie after 37 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cord prolapse management

A

Emergency c-section

Tocolytic medication to minimise contractions whilst waiting for delivery by c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

oxytocin in labour

A

stimulate ripening of cervix and contractions of uterus.

Infusions are used to 
0induce labour
-progress labour 
-imrpove frequency and strength of uterine contractions 
-prevent/ treat postpartum haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ergometrine in labour

A

stimulates smooth muscle contraction.

Useful for delivery of the placenta and to reduce postpartum bleeding.
Only used after delivery of baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

prostaglandins in labour

A

stimulate contraction of uterine muscles

Example: Dinoprostone
Used for induction of labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

nifedipine in labour q

A

CCB that reduces smooth muscle contraction in blood vessels and the uterus

reduces BP in hypertension and pre-eclampsia
-tocolysis in premature labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

terbutaline in labour

A

beta-2 agonist

acts on smooth muscle of uterus to suppress uterine contractions

used for tocolysis in uterine hyperstimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

carboprost in labour

A

synthetic prostaglandin analogue

Stimulate uterine contractions

AVOID in patients with asthma

given as deep IM injection in postpartum haemorrhage if ergometrine and oxytocin have been inadequate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

tranexamic acid in labour

A

antifibrinolytic

Reduces bleeding

Prevention and treatment of postpartum haemorrhage.

24
Q

delay in first stage of labour

A

<2cm of cervical dilatation in 4hrs

25
Q

delay in 2nd stage of labour

A

Active (pushing phase) lasts
>2 hours in nulliparous women
>1 hour in multiparous wome

26
Q

delay in third stage

A

> 30 minutes with active management (IM oxytocin and controlled cord traction)
60 minutes with physiological management

27
Q

management of failure to progress

A

amniotomy (artificial rupture of membranes)
oxytocin infusion
instrumental delivery
c-section

28
Q

options for induction of labour

A

Membrane sweet
Vaginal prostaglandins E2 (dinoprostone)
Cervical ripening balloon (CRB)
Artificial rupture of membranes+ oxytocin infusion

29
Q

monitoring during induction of labour

A

CTG
- assess fetal heart rate and uterine contractions before and during induction of labour

Bishop score
-before and during induction of labour to monitor progress

30
Q

pain relief in labour

A

Simple analgesia
Gas & air (entonox)
IM pethidine/ diamorphine
Epidural

31
Q

perineal tears

A

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

32
Q

degrees of perineal tears

A

first degree
- injury limited to frenulum of labia minor and superficial skin

2nd degree
- includes perineal muscles, but doesn’t affect anal sphincter

3rd degree

  • Includes anal sphincter but not rectal mucosa
  • 3A: <50% external anal sphincter affected
  • 3B >50% external anal sphincter affected
  • 3c: external and internal anal sphincter affected

4th degree
-includes rectal mucosa

33
Q

management of perineal tears

A

First degree; do not require sutures

Sutures to correct the injury

Reduce risk of complications

  • Broad-spectrum AB
  • Laxative
  • physio
  • follow-up
34
Q

complications of perineal tear

A

Short-term

  • pain
  • infection
  • bleeding
  • wound dehiscence or wound breakdown

Long-term

  • urinary incontinence
  • anal incontinence and altered bowel habit
  • dyspareunia
  • psychological consequences
35
Q

Epiosiotomy

A

Cuts perineum before delivery

36
Q

perineal massage

A

reduce risk of perineal tears

massaging skin and tissues between vagina and anus

37
Q

postpartum haemorrhage

A

Loss of
>500ml after vaginal delivery
>1000ml after c-section

38
Q

Cause of postpartum haemorrhage

A

tone (uterine atony)
trauma (perineal tear)
Tissue (retained placenta)
thrombin (bleeding disorder)

39
Q

management of postpartum haemorrhage (stabling patient)

A

obstetric emergency

ABCDE approach
insert two large-bore IV cannulas
Bloods: FBC, U&E, clotting screen
Group and cross match 4 units of blood
Warmed IV fluid and blood resuscitation as required
Oxygen
FFP (clotting abnormalities or after 4 units of blood transfused)

Severe:activate major haemorrhage protocol

40
Q

management of postpartum haemorrhage (stop bleeding)

A

Mechanical

  • rubbing uterus to stimulate uterus contraction
  • catheterisation

Medical

  • oxytocin
  • ergometrine
  • carboprost
  • tranexamic acid

Surgical

  • intrauterine balloon tamponade
  • B-lynch suture
  • uterine artery ligation
  • last resort: hysterectomy
41
Q

Secondary postpartum haemorrhage

A

bleeding occurs from 24 hours to 12 weeks postpartum

Likely cause
- retained products of conception or infection

Investigation

  • US
  • Endocervical and high vaginal swabs

Management

  • surgical evacuation of retained products of conception
  • antibiotics for infection
42
Q

shoulder dystocia

A

anterior shoulder of baby becomes stuck behind pubic symphysis of the pelvic, after head has been delivered

43
Q

Management of shoulder dystocia

A

1st: McRobert’s manoeuvre

Rubin’s manoeuvre

Wood’s screw manoeuvre

Zavanelli manoeuvre

44
Q

uterine inversion

A

funds of uterus drops down through uterine cavity nd cervix, turning the uterus inside out.
Very rare occurence
Life-threatening obstetric emergency

45
Q

Incomplete vs complete uterine inversion

A

Incomplete
-fundus descends inside uterus or vagina, but not as far as introitus

Complete uterine inversion
-involves uterus descending through vagina to introitus

46
Q

management of uterus inversion

A

Johnson manoeuvre

Hydrostatis methods

Surgery
-laparotomy

47
Q

uterine rupture

A

complication of labour.
Muscle layer of uterus (myometrium) ruptures

Obstetric emergency

very rare to occur in nulliparous

48
Q

incomplete vs complete uterine rupture

A

incomplete/ uterine dehiscence
-uterine serosa (perimetrium) surrounding uterus remains intact

Complete rupture
-serosa ruptures along with myometrium, and the contents of the uterus are released into peritoneal cavity

49
Q

uterine rupture presentation

A 
abdo pain 
vaginal bleeding 
ceasing of uterine contraction 
hypotension 
tachycardia

collapse

50
Q

uterine rupture management

A

resuscitation and transfusion

Emergency c-section

51
Q

maternal sepsis main aetiology

A

chorioamnionitis

UTI

52
Q

chorioamnionitis

A

infection of chorioamniotic membranes and amniotic fluid

Leading cause of maternal sepsis and notable cause of maternal death

53
Q

Presentation

A

fever, tachycardia, raised RR, reduced O2 sats, low BP, altered consciousness, reduced urine output, raised WCC
Evidence of foetal compromise on CTG

Chorioaminonitis

  • abdo pain
  • uterine tenderness
  • vaginal discharge

UTI

  • dysuria
  • urinary frequency
  • suprapubic pain or discomfort
  • renal angle pain (pyelonephritis)
  • vomiting (pyelonephritis)
54
Q

investigations of maternal sepsis

A

Blood test

  • FBC
  • U&E
  • LFTs
  • CRP
  • Clotting
  • Blood cultures
  • Blood gas (lactate, pH and glucose)

Additional

  • urine dipstick and culture
  • high vaginal swab
  • throat swab
  • sputum culture
  • wound swab
  • lumbar puncture for meningitis or encephalitis
55
Q

Sepsis 6

A

three tests

  • blood lactate level
  • blood cultures
  • urine output

three treatments

  • O2
  • empirical broad spectrum ABx
  • IV fluids
56
Q

antibiotics for maternal sepsis

A

Co-amoxiclav + metronidazole

Severe: Piperacillin/ Tazobactam + Clindamycin

Shock: Piperacillin/ Tazobactam + Clindamycin + Gentamicin

Penicillin allergic: Clindamycin + Gentamicin

3- Reproduction (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions