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Women's health > Labour and delivery > Flashcards

Labour and delivery Flashcards

1
Q

Labour : Shoulder Dystocia : Definition

A

Problem in delivery due to impaction of the anterior fatal shoulder on the mother’s pubic symphysis

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2
Q

Labour : Shoulder Dystocia : Management

A

First line :
H - call for help - medical emergency
E - evaluate for episiology
L -egs } Mc Robert’s manoeuvre of hip flexion and abduction
P - suprapubic pressure
Second line
Enter manourvre : Internal rotation of shoulder
Release posterior arm

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3
Q

Labour : Shoulder Dystocia : Key risk factors

A
  • Fetal macrosomia
  • Maternal Obesity / DM
  • Prolonged labour
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4
Q

Labour : Shoulder Dystocia : Complications : Maternal + Fetal

A
  1. Maternal
    • postpartum haemorrhage
    • perineal tears
  2. Fetal
    • brachial plexus injury
    • neonatal death
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5
Q

Labour : Stage 1 : Definition

A

Contractions
Cervical dilation 0-10cm

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6
Q

Labour : Stage 1 : 3 phases

A
  1. Latent phase
    – 0 to 3cm dilation of the cervix.
    -0.5cm per hour
  2. Active phase
    -3cm to 7cm dilation of the cervix.
    1cm per hour
  3. Transition phase
    7cm to 10cm dilation of the cervix.
    1cm per hour
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7
Q

Labour : Stage 1 : Delayed definition

A
  • Less than 2cm of cervical dilatation in 4 hours
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8
Q

Labour : Stage 2 definition

A

10cm dilatation of the cervix to delivery of the baby

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9
Q

Labour : Stage 2 : Factors involved

A

Power* : strength of uterine contraction
Passenger: Size/altitude/Lie/Presentation of foetus
Passage : Shape of pelvis

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10
Q

Labour : Transverse lie

A
  • Transverse lie – the fetus is straight side to side
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11
Q

Labour : Oblique lie

A
  • Oblique lie – the fetus is at an angle
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12
Q

Labour : Cephalic presentation

A
  • Cephalic presentation – the head is first
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13
Q

Labour : Shoulder presentation

A
  • Shoulder presentation – the shoulder is first
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14
Q

Labour : Breech presentation

A
  • Breech presentation – the legs are first. This can be:
    • Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
    • *Frank breech *– with hips flexed and knees extended, bottom first
    • *Footling breech *– with a foot hanging through the cervix
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15
Q

Labour : Stage 2 : Delayed definition

A

Active second stage of pushing lasts over:
* 2 hours in a nulliparous woman
* 1 hour in a multiparous woman

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16
Q

Labour : Stage 3 : Definition

A

The third stage of labour is from delivery of the baby to delivery of the placenta

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17
Q

Labour : Stage 3 : Delay definition

A
  • More than 30 minutes with active management
  • More than 60 minutes with physiological management
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18
Q

Labour : Shoulder Dystocia : Definition

A

Problem in delivery due to impaction of the anterior fatal shoulder on the mother’s pubic symphysis

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19
Q

Labour : Shoulder Dystocia : Management

A

First line :
H - call for help - medical emergency
E - evaluate for episiology
L -egs } Mc Robert’s manoeuvre of hip flexion and abduction
P - suprapubic pressure
Second line
Enter manourvre : Internal rotation of shoulder
Release posterior arm

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20
Q

Labour : Shoulder Dystocia : Key risk factors

A

Fetal macrosomia
Maternal Obesity / DM
Prolonged labour

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21
Q

Labour : Shoulder Dystocia : Complications

A
  1. maternal
    • postpartum haemorrhage
    • perineal tears
  2. fetal
    • brachial plexus injury
    • neonatal death
22
Q

Oligohydramnios : Definition

A

Reduced amniotic fluid < 500ml at 32-36 weeks

23
Q

Oligohydramnios : Causes

A
  • premature rupture of membranes
  • Potter sequence
    • bilateral renal agenesis + pulmonary hypoplasia
  • intrauterine growth restriction
  • post-term gestation
  • pre-eclampsia
24
Q

Induction of labour : Definition

A

Induction of labour describes a process where labour is started artificially

25
Induction of labour : Indications
1. **Prolonged pregnancy** e.g. 1-2 weeks after the estimated date of delivery 2. **Prelabour premature rupture of the membranes** where labour does not start 3. **Maternal medical problems** * diabetic mother > 38 weeks * pre-eclampsia * obstetric cholestasis 4. **Intrauterine fetal death**
26
Induction of labour : Bishop’s score
1. 2. 3. *Cervical position* : Posterior/Intermediate/Anterior *Cervical consistency*: Firm/Intermediate/Soft *Cervical effacement*: 0-30%/40-50%/60-70%/80% *Cervical dilation* - <1 cm/1-2 cm/3-4 cm/>5 cm *Fetal station*: -3/-2/-1, 0/+1,+2 * < 5 : Requires induction * >8 : Spontaneous labour is likely
27
Induction of labour : Mx of Bishop score < 6
1. Membrane sweep : separtion of the chorionic villi with vaginal exam. 2. Vaginal prostaglandin or Oral Misoprostol
28
Induction of labour : Mx of Bishop score >6
1. Amniotomy : artificially rupture of the amniotic sac 2. IV Oxytocin infusion
29
Induction of labour : Complication
1. Uterine hyperstimulation : very frequent contraction -Limit blood flow to foetus and cause hypoxymaeia Mx : Remove prostaglandins or stop IV oxytocin infusion\
30
Prematurity : Definition
< 37 weeks of gestation Non viable < 23 weeks
31
Preterm labour : Proxylaxis
1. Vaginal progesterone 2. Cervical cerclage : stitch the cervix to keep it closed
32
Preterm Prelabour Rupture of membranes : Definition
* The*amniotic sac* ruptures, releasing *amniotic fluid* * Before the onset of labour and * In a preterm pregnancy (under 37 weeks gestation)
33
Preterm Prelabour Rupture of membranes : Diagnosis
1. Speculum examination : revealing pooling of amniotic fluid in the vagina. 2. *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
34
Preterm Prelabour Rupture of membranes : Management
1. *Prophylactic antibiotics* * given to prevent the development of *chorioamnionitis* * Erythromycin 250mg four times daily for ten days, or until labour is established if within ten days. 2. *Induction of labour* may be offered from 34 weeks to initiate the onset of labour.
35
Preterm Labour with Intact Membranes : Definition
1. Preterm labour with intact membranes involves regular painful contraction and cervical dilatation * Without rupture of the amniotic sac.
36
Preterm Labour with Intact Membranes : Diagnosis
***< 30 weeks gestation*:** Speculum and clinical assessment of cervical dilatation ***>30 weeks gestation***: 1. *transvaginal ultrasound* can be used to assess the *cervical length*. * cervical length on ultrasound < 15mm, management of preterm labour can be offered * *Fetal fibronectin* : alternative to US Fetal fibronectin is the “glue” between the chorion and the uterus, and is found in the vagina during labour
37
Preterm Labour with Intact Membranes : Management
1. *Fetal monitoring* (CTG or intermittent auscultation) 2. *Tocolysis with nifedipine*: nifedipine is a calcium channel blocker that suppresses labour 3. *Maternal corticosteroids*: can be offered before 35 weeks gestation to reduce risk of respiratory distress syndrome 4. *IV magnesium sulphate*: can be given before 34 weeks gestation, reduces risk of cerebral palsy 5. *Delayed cord clamping* or *cord milking*: can increase the circulating blood volume and haemoglobin in the baby at birth
38
Umbilical chord prolapse : definition
1. *Umbilical cord* descends below the presenting part of the fetus and through the cervix into the vagina 2. After rupture of the fetal membranes. 3. There is a significant danger of the presenting part compressing the cord, resulting in *fetal hypoxia*.
39
Umbilical chord prolapse : Diagnosis
1. CTG : fetal distress 2. Vaginal / Speculum : shows umbilical chord
40
Umbilical chord prolapse : Management
1. Push up presenting part of foetus to prevent chord compression 2. Tocolytic medication - to minimise contraction Definitive management : Emergency C section
41
Breech presentation : Definition
baby is positioned feet or buttocks first in the uterus instead of the head-first position, which is the typical and safest presentation for childbirth. Frank breech - most common presentation
42
Breech presentation : Risk factors
1. Uterine malformation : Fibroids, Placenta Previa 2. Amniotic fluid : Polyhydramnios or Oligohydramnios 3. Prematurity 4. Fetal abnormality
43
Breech presentation : Management
1. <36 weeks : most will turn spontaneously 2. >36 weeks : External cephalic version * Avoid if major uterine anomaly, ruptured membrane, bleeding, multiple pregnancy 3 .. Remains breech : C section
44
Breastfeeding : Drug CI
* antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides * psychiatric drugs: lithium, benzodiazepines * aspirin : increases risk of bleeding disorders in newborns due to vitamin K inhibition * carbimazole * methotrexate * sulfonylureas * cytotoxic drugs * amiodarone : high half
45
Uterine rupture : Risk factors
* RF * Previous C section < 18 months * Macrosomia * High parity Presents with - sig haemodynamic compromise,
46
Post-date - >40 weeks
No sign of labour after 40 weeks 1. Membranę sweep 2. Medical induction of labour at 41-42 weeks via Vaginal prostaglandin pessary
47
Risks of C section
DVT, PE, Bleeding * Injury to bladder or down
48
Neontal infection
Conjunctival gonorrhoea - 5 days following delivery Meconium passed in utero - can be a sign of foetal distress. Risk of foetal meconium aspiration
49
UK perimortality rate
Number of stillbirths and early neonatal deaths <7 days per 1000 live births and still births
50
51
NSAID in pregnancy
NSAID - avoid in third trimester Risk of ductus arterioles closing Oligohydramnios

Women's health (12 decks)

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