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repro > labour and delivery > Flashcards

labour and delivery Flashcards

1
Q

define labour

A

progressive effacement ( and dilatation of the cervix in the presence of regular uterine contractions

can have open cervix without contractions but thats not labour

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2
Q

define delivery

A

expulsion of fetus and placenta

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3
Q

define show in labour and delivery

A

cervical mucus plug ppl will present with bleeding basically like snot with blood in it

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4
Q

define SRM in labour

A

spontaneous rupture of membranes, can preced labour

bag membranes around baby breaks can happen prematurely

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5
Q

define ARM in labour

A

artificial rupture of membranes

colour of fluid can present concerns

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6
Q

miscarriage

A

before 24 weeks or less than 500g

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7
Q

at what cm does full effacement happen

A

3-4 cm of dilaltation

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8
Q

what is latent first stage

what is establishes/active 1st stage of labour is

A

latent

  • painful contractions
  • upto 4cm cervical change

Active
regular contractions 3/4x every 10 minutes

3-4cm dilated

progressive cervical dilatation from 4 cm
cervix fully dialted 10cm

fully dilated til when baby comes out

BABY comes out of palcenta

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9
Q

factors affecting labour

A

passage
- pelvis and symbodian passage anf muscular passage

powers
- contraction

passenger
- baby

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10
Q

the passage in labour

A

pelvic inlet - baby faces towards hips

mid cavity -rotates

pelvic outlet - look down at floor

Soft tissues
Lower uterine segment
- issues arise if they had FGM

Cervix
- if they had cervical cancer Tx then it will weaken the cervical wall, stop dilating

Vagina
Vulva

Pelvic floor
Perineum
- if they look like they gonna tear do episiotomy clinicians judgement

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11
Q

powers in labour

A

There is fundal dominance of contractions

Contraction are rhythmic and occur every 3-4 minutes in early labour, and every 2-3 minutes in advanced labour

3/4x every 10 minutes - start at fundus and work down

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12
Q

passenger in labour

A

Lie relationship of fetal long axis of the baby to that of the mother (long, oblique, transverse)

Presentation the part of the fetus lowermost in the uterus HEAD FIRST (cephalic: vertex, brow, face; breech; shoulder)

Denominator part of fetus used as reference point to describe position in maternal pelvis (occiput, mentum - chin, sacrum - breech, acromion)
Position relation of the fetal denominator to the maternal pelvis (occipitoanterior, occipitotransverse, occipitoposterior)

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13
Q

define each term occipitoanterior, occipitotransverse, occipitoposterior)

A

occipitoanterior - head at the top chin on chest

occipitotransverse - ladies right

occipitoposterior - baby looking at ceiling - prolonged labour in first and second stage

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14
Q

how is passenger position assessed

A

vaginal examination
look for 2 fontanelles

posterior fontanelles is where occiput is look at position triangle shape

anterior is diamond shape

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15
Q

why do we worry about position of head

A

degree of flexion/extension of head makes a big difference to the circumference

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16
Q

grading of moulding of fetal cranium

A

bones not moved - 0

bones not touching 1+

bones overriding but can be pushed apart 2+

bones overriding but cannot be pushed apart 3+

caput - swelling of head

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17
Q

mechanism of labour

A
  1. engagement - baby fixed in pelvis 1/5ths? 2/5th is in pelvis unlikely to move
    imp
  2. flexion - chin on chest
  3. descent
  4. internal rotation - occipitoanterior, pelvic floor helps with this
  5. extension
  6. external rotation
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18
Q

why is engagement importnat in assessing assisted vaginal delivery

A

important in assisted vaginal delivery as you should not feel any of the head

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19
Q

what is monitored in the mother during labour

A

Observations BP, P, T
Hydration
Analgesia
Antacids - high risk rinatidine every 6 hours
Bladder care - voiding regularly, if epidural give indwelling catheter

Position - lie on back uterus presses in BVs in turn causing hypo then bradycardia

Progress contractions
cervical dilatation
descent of presenting part

3rd stage active management
- give injection or oral infusion of oxytocin reduces bleeding and second stage and controlled cord traction

Perineum - check for trauma

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20
Q

why is monitoring bladder important

A

can obstruct

can give bladder dysfunction post delivery

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21
Q

fetal wellbeing how is it checked

A

Fetal Heart Monitoring
high risk continuous monitoring on CTGs

Colour of Liquor
clear
pinky
blood stained
meconium- fetal distress
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22
Q

what is station in terms of descent

A

station how far down has the baby head descended into the pelvis

locating where the lowest part of your baby is in relation to your pelvis

how far the widest part of baby head (biparietal) diameter in conjunction with the narrowest part of the pelvis ischial spine
-1 cm above

+2 baby head is about to come out

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23
Q

what is normal progress in labour

A

1cm every hour

1/2 cm every hour

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24
Q

common problems in labour

A

failure to progress (delay in 1st or 2nd stage)

malpresentation/malposition

suspected fetal compromise (fetal distress)

vaginal birth after c section

operative delivery

shoulder dystocia

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25
Q

what is failure to progress

A

Can occur in first or second stage
Causes: Powers Passenger Passage

POWER
Inadequate contractions
Maternal Exhaustion

PASSENGER
Fetal malposition/malpresentation
Cephalopelvic disproportion (relative, absolute - baby cant come thru pelvis)

PASSAGE
Obstructed Labour - kaput and moulding, haematuria, vulval swelling, cervix becomes oedematous

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26
Q

qs to ask when the labour is failing to progress

A 
Parous or nulliparous? 
First or Second Stage? 
Frequency Duration Strength of Contractions?
Malpresentation/Malposition?
Evidence of fetal compromise?
Evidence of Obstructed Labour?

If inefficient uterine contractions are the cause, augment labour with Oxytocin.
Remember that a parous uterus can rupture

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27
Q

what is secondary arrest

A

no change in cervical dilation for at least 2 hours.

  • what sort of analgesia
  • hey may get an overwhelming feeling if pushing

leave them an hour WO pushing

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28
Q

types of breech

A

frank

complete

footling

29
Q

breech complications

A

trapped aftercoming head
cord prolapse

intracranial haemorrhages - head is squeezed kaput compression and decompression rapidly

internal injuries - shouldnt pull baby as there is moral reflex

30
Q

delivery options for breech presentation

A

External Cephalic Version

Elective Caesarean Section

Vaginal breech delivery

31
Q

suspected fetal compromise on CTG signs

A
  • Absence of acceleration (non-reactive) - HR goes up 15 beats for more than 15s
  • Presence of decelerations
  • Reduced baseline variability (flat) - 5-10 BPM
  • Baseline tachycardia or bradycardia

Passage of Meconium - have babies opened up bowels

32
Q

causes of suspected fetal compromise

A

uterine hyperstimulation ( ? iatrogenic)

hypotension - women lying on her back causing fetal distress
another cause is epidural

poor fetal tolerance of labour (e.g. IUGR)

cord compression - normal CTG short sharp deeleration w contractions u get fetal hypotension

infection - fetal pyrexia

maternal disease -

33
Q

management of suspected fetal compromise

A

bradycardia - less than 100 BPM
3 mins call for help
6 mins theatre
6 mins baby out

rectify reversible causes, e.g. maternal hypotension

left lateral position - do not lie flat

stop oxytocics

confirm compromise by blood sampling where possible

deliver by speediest route if unable to correct or if significant acidosis

34
Q

risks of vaginal birth after caesarean

A

Emergency Caesarean section in labour

Uterine scar dehiscence/rupture 0.5%

35
Q

precautions of VBAC

A

iv access and G&S
continuous electronic fetal monitoring
avoid prolonged labour
augmentation/induction should be senior decision only

36
Q

indications for operative delivery

A

failure to progress in 2nd stage, maternal exhaustion, maternal problems

fetal distress in 2nd stage

maternal reasons - maternal exhaustion, cardiac issues LESS COMMON THAN FIRST TWO

37
Q

pre requisites for operative delivery

A
  • trained operator
  • full dilatation
    absent membranes
    cephalic presentation
    clearly defined position
    presenting part engaged
    no evidence of Cephalic Pelvo Disproportion
    adequate analgesia - epidural, pudendal nerve blocks
    empty bladder
38
Q

complications of operative delivery

A

failure
fetal trauma - cephalohaematomas - blood between skin and bone

lacerations from ventouse

maternal trauma - common with forceps

postpartum haemorrhage

urinary retention - common esp with a full bladder

39
Q

indications for caesarean section

A

failure to progress

fetal distress maternal reasons - previous C section malpresentation/malposition failed instrumental delivery

40
Q

pre-requisites for caesarean section

A

trained operator

adequate facilities adequate analgesia consultation with senior member of staff

41
Q

complications of C-section

A

haemorrhage
infection bladder/bowel injury thromboembolic disease requirement for blood transfusion
TTN - Transient tachypnea of the newborn - thue dont scream go to special care unit
fetal trauma

42
Q

define shoulder dystocia

A

Inability to deliver shoulders after delivery of head

Anterior shoulder does not enter pelvic inlet

43
Q

risks of shoulder dystocia

A
  • Fetal Death
  • Asphyxia with resulting hypoxic damage
  • Birth trauma (Erb’s palsy, fractured bones)
    • physio
    • surgery
  • Maternal trauma (soft tissue trauma, psychological)
  • PPH
  • perineal tears
44
Q

who is at risk of shoulder dystocia

A
  • Macrosomic fetus
  • Fetus of diabetic mother indication for C section
  • Rotational instrumental delivery
  • prolonged labour
  • high BMI
45
Q

management of shoulder dystocia

A 
McRoberts position
suprapubic pressure
other obstetric manoeuvres
zavanelli
cut pubic symphysis - baby would not survive
46
Q

what is the mcroberts position

A

The McRoberts’ manoeuvre is flexion and abduction of the maternal hips, positioning the maternal thighs on her abdomen.

47
Q

why do we worry about shoulder dystocia

A

when baby gasp cant expand lungs chest is still in canal so not getting oxygen anywhere so gets hypoxic

48
Q

what is latent first stage of labour

A

a period of time, not necessarily continuous, when:

there are painful contractions and

there is some cervical change, including cervical effacement and dilatation up to 4 cm.

49
Q

what adivse can be given to the woman during laternt first stage of labour to reduce pain

A

breathing exercises

immersion in water

massage may reduce pain

50
Q

what is the bishop score

A

predict the success of induction.

It assesses the favourability of the cervix and is based on; dilatation, effacement, station, position and consistency of the cervix.

Bishop score is inversely correlated with the labour duration; a patient with score > 8 is likely to achieve a successful vaginal birth without induction. A score of <6 indicates that cervical ripening may be required.

Interpretation
a score of < 5 indicates that labour is unlikely to start without induction
a score of > 9 indicates that labour will most likely commence spontaneously

51
Q

RFs for breech

A
  • uterine malformations, fibroids
  • placenta praevia
  • polyhydramnios or oligohydramnios
  • fetal abnormality (e.g. CNS malformation, chromosomal disorders)
  • prematurity (due to increased incidence earlier in gestation)
52
Q

what is major placental praevia

A

when the placenta covers the internal os of the cervix

53
Q

RFs for placental praevia

A
  • previous history of placental praevia
  • previos C section
  • Advancing maternal age.
  • Increasing parity.
  • Smoking.
  • Cocaine use during pregnancy.
  • Previous spontaneous or induced abortion.
  • Deficient endometrium due to past history of, for example, endometritis, manual removal of placenta, curettage.
  • Assisted conception.
54
Q

presentation of placental praevia

A

incidental finding

painless bleeding after the 28th week - spotting earlier

55
Q

all babies at breech at term need to have what as a follow up

A

USS of hip 6 weeks following delivery

56
Q

initial Mx of breech

A

external cephalic version

57
Q

Risk of ECV to mum and foetus

A

MATERNAL RISKS

  • pain
  • rhesus sensation
  • EMCS

FOETAL RISKS

  • reversion
  • Foetal Heart Rate changes
  • unsuccessful
58
Q

what is rhesus sensitisation

A

Sensitisation happens when a woman with RhD negative blood is exposed to RhD positive blood, usually during a previous pregnancy with an RhD positive baby. The woman’s body responds to the RhD positive blood by producing antibodies (infection-fighting molecules) that recognise the foreign blood cells and destroy them.

If sensitisation occurs, the next time the woman is exposed to RhD positive blood, her body produces antibodies immediately. If she’s pregnant with an RhD positive baby, the antibodies can cross the placenta, causing rhesus disease in the unborn baby. The antibodies can continue attacking the baby’s red blood cells for a few months after birth.

59
Q

what are the delivery options if the baby is breech

A

c section

vaginal breech birth

60
Q

issue with C section that affects the future

A

scarred uterus

61
Q

what can scarred uterus cause

A

placental disease

uterine rupture

62
Q

main risk of vaginal birth after C section

A

uterine rupture

63
Q

what drug is administerd for active third stage labour

A

oxytocin
- Uterotonic drugs
- Deferred clamping and cutting of cord, over 1 minute after delivery but less then 5 minutes
- Controlled cord traction after signs of placental separation
if HTN do not give ERGOMETRINE

64
Q

what is cord prolapse

A

umbilical cord descending ahead of the presenting part of the fetus.

this can lead to compression of the cord or cord spasm, which can cause fetal hypoxia and eventually irreversible damage or death.

65
Q

RFs of cord prolapse

A 
prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie
placenta praevia
long umbilical cord
high fetal station
66
Q

what conditions would warrant a CTG monitoring

A
  • Abnormal fetal growth
  • Maternal HR >120 on 2 occasions 30 mins apart
  • Temp >38 (or >37.5 on 2 consecutive occasions 1 h apart); or suspected chorioamnionitis or sepsis
  • Presence of significant meconium
  • Fresh PV bleeding that develops in labour
  • HTN +/- significant proteinuria
  • Confirmed delay in 1st or 2nd stage
  • Contractions >60s or >5/10
  • Syntocinon
  • Epidural analgesia
67
Q

features of OP delviery

A

delivery is possible

  • augmentation shoulf be used if progress is slow
  • kiellan’s forceps are ass w most successful outcomes
  • women have an earlier urge to push in OP than OA
68
Q

give features that are assessed during a vaginal examination in labour

A

consistency, effacemtn, dilation of the cervix

  • whether the membranes are intact
  • colour of the amniotic fluid
  • nature and presentation of the presenting part and its relationship tothe ischial spines
  • size of pelvic outlet
69
Q

when is placenta expelled

A

within 30 mins

if it fails -> oxytocin then surgery

repro (28 decks)

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