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Obstetrics And Gynaecology > Labour And Delivery > Flashcards

Labour And Delivery Flashcards

1
Q

What are signs of labour?

A

Show, rupture of membranes, regular+painful contractions, dilating cervix

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2
Q

What is meant by rupture of membranes?

A

The amniotic sac has ruptured

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3
Q

What is meant by SROM?

A

Spontaneous rupture of membranes- the amniotic sac has ruptured spontaneously

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4
Q

What is meant by PROM?

A

Premature rupture of membranes- amniotic sac has ruptured before the onset of labour
OR
Prolonged rupture of membranes- the amniotic sac ruptures more than 18 hours before delivery

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5
Q

What is meant by P-PROM?

A

Preterm premature rupture of membranes- the amniotic sac has ruptured before the onset of labour and before 37 weeks gestation

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6
Q

Who is offered progesterone for prophylaxis of preterm birth?

A

Women with a cervical length of less than 25mm on vaginal ultrasound between 16-24 weeks gestation

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7
Q

What is cervical cerclage?

A

Putting a stitch in the cervix to keep it closed and add support for women at risk of preterm labour, this is removed when women reach term or go into labour

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8
Q

What are the causes of postpartum haemorrhage? remembered by the 4 T’s

A

Tone- Atony of uterus
Trauma- injury to birth canal or tear
Tissue- retained placenta or foetal tissue
Thrombin- coagulopathies

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9
Q

What interventions can improve outcomes in preterm labour?

A

Fetal monitoring (CTG or intermittent auscultation), tocolysis with nifedipine, maternal corticosteroids (reduce RDS risk in neonates), IV magnesium sulphate (protects baby’s brain), delayed cord clamping

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10
Q

What is tocolysis?

A

Stopping uterine contractions using medications

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11
Q

What is nifedipine and what is atosiban?

A

Nifedipine- calcium channel blocker
Atosiban- oxytocin receptor antagonist

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12
Q

What would be an example corticosteroid routine given to women with suspected preterm labour of babies <36 weeks?

A

Two doses of IM betamethasone 24 hours apart

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13
Q

What are key signs of magnesium toxicity?

A

Reduced resp rate, reduced blood pressure, absent reflexes

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14
Q

What is a bishop score?

A

A score used to determine whether to induce labour

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15
Q

What is maximum bishops score?

A

13

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16
Q

What does a score above 8 and a score below 8 on the bishops score mean?

A

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

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17
Q

What are some options for induction of labour?

A

Membrane sweep, vaginal prostaglandin E2, cervical ripening balloon, artificial rupture of membranes with an oxytocin infusion

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18
Q

What can be used to induce labour where intrauterine fetal death has occurred?

A

Oral mifepristone plus misoprostol

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19
Q

What does failure to progress mean?

A

When labour is not developing at a satisfactory rate which increases risk to foetus and mother

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20
Q

Is failure to progress more common in women who’ve had multiple previous pregnancies or those in labour for the first time?

A

Those who have not had previous births

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21
Q

Progress in labour is influenced by what three Ps?

A

Power: uterine contractions
passenger: size, presentation and position
passage: shape and size of pelvis and soft tissues

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22
Q

When is there considered to be a delay in the first stage of labour?

A

Less than 2cm dilatation in 4 hours, slowing of progression in a multifarious woman

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23
Q

What is recorded on a partogram?

A

Cervical dilatation, descent of fetal head, maternal obs (pulse, HR, BP, temp, urine output), fetal HR, frequency of contractions, status of membranes, drugs given

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24
Q

How are uterine contractions measured?

A

Number of contractions per 10 minutes

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25
Q

What is amniotomy?

A

Articulacy rupturing the membranes

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26
Q

When plotting the cervical dilatation on a partogram what needs to be done if the points cross the alert and action lines?

A

Alert: indicates amniotomy
Action: care is escalated to obstetric led care ad senior decision makers

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27
Q

When is there considered to be a delay in the second stage of labour?

A

When active second stage (pushing) lasts over 2 hours in nulliparous women or more than 1 hour in multifarious women

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28
Q

What can be used if there are weak uterine contractions delaying delivery of the baby?

A

Oxytocin infusion

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29
Q

When talking about ‘passenger’, what are the four descriptive qualities?

A

Size, attitude, lie and presentation

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30
Q

What defines a delay in the third stage of labour (delivery of baby to delivery of placenta)?

A

More than 30 minutes with active management
More than 60 minutes with physiological management

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31
Q

What are things that can improve symptoms of labour without medications?

A

Information about what to expect, having good support relaxed environment, changing position to stay comfortable, controlled breathing, TENS machine in early stages of labour

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32
Q

What simple analgesia is used in labour, which are not used?

A

Paracetamol is used, so is codeine
NSAIDs are avoided

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33
Q

What is involved in an epidural?

A

Insertion of a small tube into epidural space in the lower spine, this outside the duramater, and local anaesthetic is infused into this space

34
Q

What anaesthetics are used in an epidural commonly?

A

Bupivacaine or levobupivacaine, usually mixed with fentanyl

35
Q

What are some adverse effects of an epidural?

A

Increased probability of instrumental delivery, headache, hypotension, motor weakness in legs, nerve damage, prolonged second stage

36
Q

What needs to be in place when a woman in labour is using patient controlled anaesthesia?

A

Anaesthetic input, naloxone in case of resp depression, atropine in case of bradycardia

37
Q

What ar the sides effects of IM pethidine or diamorphine used as pain relief in labour?

A

Can make mother nauseous or drowsy, if given too close to birth neonate may have respiratory depression

38
Q

What is the most significant risk factor for cord prolapse?

A

Foetus in abnormal lie after 37 weeks gestation

39
Q

When should cord prolapse be suspected?

A

When there are signs of fetal distress on CTG

40
Q

How is cord prolapse diagnosed?

A

Speculum examination

41
Q

What is the management of cord prolapse?

A

Emergency C section
Do not push cord back in, handling can result in vasospasm
Get women to lie in left lateral position or knee-chest position, tocolytic meds can be given while waiting for C section

42
Q

What is shoulder dystocia?

A

When the anterior shoulder of the baby gets stuck behind the pubic symphysis after head is delivered

43
Q

What is failure of restitution seen in shoulder dystocia?

A

Head of baby remains downwards and does not turn sideways as expected after delivery of the head

44
Q

What is the turtle neck sign seen in shoulder dystocia?

A

Where the head is delivered but retracts back into the vagina

45
Q

What is McRoberts manoeuvre?

A

Get the woman to flex their hips (bringing knees to abdomen) which causes a posterior pelvic tilt moving the pubic symphysis

46
Q

What are the key complications of shoulder dystocia?

A

Fetal hypoxia, brachial plexus injury + Erb’s palsy, perineal tears, postpartum haemorrhage

47
Q

What does having an instrumental delivery increase the risk of for mothers?

A

Postpartum haemorrhage, episiotomy, perineal tears, nerve injury (obturator or femoral)

48
Q

What is the key risk to baby with ventouse and forceps delivery?

A

Cephalohaematoma with ventouse
Facial nerve palsy with forceps

49
Q

If a baby has hardened lumps of fat on their face following forceps delivery, what is this likely to be? What will happen to these lumps?

A

Fat necrosis, this will resolve itself over time

50
Q

What symptoms can a woman have if her obturator nerve is damaged during an instrumental delivery or by fetal head during normal delivery?

A

Weakness of hip adduction and rotation, numbness of medial thigh

51
Q

What symptoms can a woman have if her femoral nerve is damaged during an instrumental delivery?

A

Weakness of knee extension, loss of patellar reflex and numbness over anterior thigh and medial lower leg

52
Q

What does para refer to in an obstetric patient?

A

The number of times a woman had given birth after 24 weeks gestation, regardless of wether foetus was alive or not

53
Q

What does nulliparous, primiparous and multiparous mean?

A

Nulliparous= not given birth to a baby after 24 weeks before
Primiparous= has given birth to a baby after 24 weeks once before
Multiparous= has given birth to a baby after 24 weeks more than once before

54
Q

How often would we expect contractions in early labour?

A

Every 3-4 minutes

55
Q

How often would we expect contractions in advanced labour?

A

Every 2-3 minutes

56
Q

What shapes do the different font Allen’s tend to be?

A

Posterior tends to be more V shaped whereas anterior is more like a diamond

57
Q

What are the the 6 parts of the mechanism of labour?

A

Engagement, flexion, descent, internal rotation, extension, external rotation

58
Q

What are risks of an abnormal lie at delivery?

A

Significant risk of cord prolapse or uterine rupture

59
Q

What are some complications of breech delivery?

A

Trapped head, cord prolapse, intracranial haemorrhage, internal injuries

60
Q

If during CTG monitoring of a baby during labour there appears to be suspected fetal compromised, what could be causing this?

A

Uterine hyper stimulation, hypotension (from epidural or positioning during labour), poor fetal tolerance of labour (e.g IUGR), cord compression, infection

61
Q

If a woman in labour has hypotension, how can we get them to move to relieve this?

A

Left lateral position (get them to turn on their left side)

62
Q

What are indications for instrumental delivery?

A

Fetal distress or/and failure to progress in second stage, maternal exhaustion

63
Q

How often do roberts manouevre and suprapubic pressure help overcome shoulder dystocia?

A

90-95% of cases

64
Q

What are two key causes of sepsis in pregnancy?

A

Chorioamnionitis, UTIs

65
Q

What are the two parts of the second stage of labour?

A

Passive (non-voluntary pushing) and active where mum is pushing voluntarily

66
Q

What are the five features of a bishops score?

A

Dilatation, effacement, station, consistence and position

67
Q

What rate or cervical dilatation would we expect in the active phase of the first stage of labour?

A

2cm every 4 hours

68
Q

What is a non-pharmacological option for pain relief in labour? When can this be used?

A

TENS machine, only used in early labour

69
Q

What inhalation method can be given for pain relief in labour?

A

ENOX (50:50 oxygen and nitrogen)

70
Q

What IV and IM opioids are commonly given for pain relief in labour?

A

Pethidine or diamorphine

71
Q

What are the risks of opioids for pain relief in labour?

A

Woman can become drowsy, nauseous or sick
Baby can have short term respiratory depression and drowsiness when born

72
Q

What is an epidural?

A

An injection of local anaesthetic in to the space outside the dura mater which acts to numb the spinal nerves and block pain signalling in them

73
Q

What are the risks with an epidural?

A

Hypotension, temporary loss of bladder control, nausea, headache, nerve damage, procedure failure

74
Q

What is the gold standard investigation for preterm labour?

A

Transvaginal ultrasound for cervical length

75
Q

At what cervical length would we determine preterm labour and offer treatment?

A

Less than 15mm

76
Q

What swab can be used to see if a woman is at risk of preterm labour?

A

Actim-partus, this measures phosphorylated IGFBP-1 and is an endocervical swab

77
Q

How is uterine tamponade applied in an major obstetric haemorrhage?

A

Through bakri balloon

78
Q

What is postpartum thyroiditis?

A

A condition where there are changes to thyroid function seen within 12 months of giving birth in women without previous thyroid disease

79
Q

What is the prognosis of postpartum thyroiditis?

A

Generally resolves over time (by 1 year) returning to normal levels, a small portion of women will need long term thryoid management

80
Q

What is the management for postpartum thyroiditis?

A

Hyperthyroidism- symptomatic treatment with propanolol
Hypothyroidism- levothyroxine

Obstetrics And Gynaecology (8 decks)

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