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Obs & Gynae > Labour and delivery > Flashcards

Labour and delivery Flashcards

1
Q

Definition of labour

A

Progressive uterine contractions with progressive cervix dilation and formation of forewater

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2
Q

What is forewater and hindwater

A

Forewater - amniotic fluid below fetal head with tense membrane

Hindwater - amniotic fluid above fetus

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3
Q

Stages of labour

A

1: onset of labour to cervical dilation of 10cm
2: dilation to expulsion of fetus
3: expulsion of placenta

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4
Q

Parts of the pelvis that make the birth canal

A

Pelvic inlet
Mid cavity (ischial spines)
Pelvic outlet

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5
Q

What is the only fixed diameter of fetal head

A

9.5cm biparietal diameter

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6
Q

What is the smallest presenting diameter of the fetal head

A

9.5cm suboccipital to bregma diameter

Occipital anterior position

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7
Q

What is the presenting diameter in occipital posterior position

A

13.5cm suboccipital to brow

Therefore need C/S

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8
Q

Definition of position

A

Relationship of presenting part of fetus to quadrants of pelvic outlet

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9
Q

Definition of station

A

Relationship of biparietal diameter to ischial spines

-3 to +3

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10
Q

What station does internal rotation occur

A

0

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11
Q

Describe internal rotation

A

45 degree rotation
Occipit becomes anterior
Shoulders do not rotate

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12
Q

What is restitution

A

Head corrects itself to facing forwards once delivered

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13
Q

How are the shoulders delivered

A

After restitution the head externally rotates so the shoulders are in the AP plane of the pelvic outlet and can be delivered

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14
Q

What are the sub stages of stage 1 of labour

A

Latent: softening of cervix, effacement, shortening of cervix and dilation up to 4cm (up to 20 hours in nulliparous and 14 hours in multiparous)

Active: dilation of cervix at a minimum rate of 2cm every 4 hours

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15
Q

What are the sub stages of stage 2 of labour

A

Passive pushing: allow 1 hour for passive pushing for fetal head to descend. Only in women with an epidural.

Active pushing: expect head to deliver within 1 hour

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16
Q

Reasons for prolonged labour in first stage

A 
Weak uterine contractions
Slow effacement of cervix
Occipitoposterior position
Nill parity
Large fetus 
Abnormal presentation 
Multiple pregnancy
17
Q

Management of prolonged first stage labour

A

Oxytocin infusion

ARM if not already ruptured and bishops >7

18
Q

Why is oxytocin used in caution with diabetes and asthma

A

Has ADH effect so can cause severe water retention

19
Q

Side effects of oxytocin

A 
Hyperstimulation of uterus and uterine rupture 
Headache
Arrhythmia
N+V
Dyspnoea
Hypotension
20
Q

What drugs can be given to speed up 3rd stage of labour

A

Syntometrin

Syntocinon 10 units

21
Q

Side effect of ergometrine

A

Headache
Nausea
Hypertension

22
Q

What is measured in bishops score

A 
Position of cervix
Position of baby's head
Consistency of cervix
Effacement
Dilation
23
Q

What does bishops score mean

A

Higher the number /10 the more likely labour will progress without intervention

24
Q

What bishop score means that labour is unlikely to progress

A

Below 6

25
Q

What bishop score can you do an ARM for

A

Above 7

26
Q

How do you induce a stillbirth

A

Give misoprostol

27
Q

3 Ps of labour

A

Power
Passenger
Passage

28
Q

How to assess power of labour

A

Observation
Manual palpation
CTG

29
Q

What comes under passenger

A

Number of foetuses
Presentation - pole overlying maternal pelvic inlet (breech or cephalic)
Position - relation of presenting part of fetus to quadrants of maternal pelvis. Should be occipital anterior.
Station - relation of biparietal diameter to ischial spines
Lie - relation of fetus to long axis of uterus

30
Q

What makes the pelvic inlet

A

Sacral promontory
Lines terminalis (pectineal line, arcuate line, pubic crest)
Pubic symphysis

31
Q

What makes the pelvic outlet

A

Pubic arch
Ischial tuberosities
Sacrotuberous ligaments
Coccyx

32
Q

What is prolonged 1st stage of labour

A

Active phase at least 2 hours longer than expected
I.e 4-10cm should take 1.2cm/hour (nulliparous) and 1.5cm/hour (multiparous)
Therefore over 7 hours or 6 hours respectively

33
Q

What is prolonged 2nd stage of labour

A

Nulliparous: >3 hours with epidural or >2 hours
Multiparous: >2 hours with epidural or >1 hour

34
Q

What is prolonged 3rd stage of labour

A

30 minutes

35
Q

Risks of instrumental delivery

A

Cephalohaematoma
Temporary facial nerve paralysis (compression at stylomastoid foramen)
Bruising
Brachial plexus injuries

36
Q

Contraindications for instrumental delivery

A 
Any presentation other than cephalic 
<34 weeks
Cervix not fully dilated
Membranes not ruptured
Bladder not emptied
37
Q

Management of delayed 2nd stage

A

Oxytocin +/- epidural for analgesia
Instrumental delivery
Consider C/S

38
Q

Assessment of newborn

A 
Examine at 1,5,10 minutes after delivery 
APGAR:
Appearance 
Pulse
Grimace - reflex, irritability
Activity
Respiration

Obs & Gynae (37 decks)

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