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Obs and Gynae > Labour and Delivery > Flashcards

Labour and Delivery Flashcards

1
Q

Define the first stage of labour

A

Cervical dilatation to 10cm

Cervical effacement i.e. thinning

“show” i.e. mucus plug falls out

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2
Q

At what rate does cervical dilatation occur during the latent phase of FSL?

A

0.5cm per hour

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3
Q

At what rate does cervical dilatation occur during the active phase of FSL?

A

1cm per hour

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4
Q

At what rate does cervical dilatation occur during the transition phase of FSL?

A

1cm per hour

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5
Q

Define Braxton-Hicks contractions

A

Occasional irregular contractions of the uterus

Felt in 2nd/3rd trimester

Do not progress or become regular

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6
Q

What four things demonstrate the onset of labour?

A

Show

Rupture of membranes

Painful regular contractions

Dilating cervix

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7
Q

At what point of cervical dilatation is first stage of labour established?

A

from 4cm onwards

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8
Q

Define prematurity

A

<37 weeks gestation

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9
Q

Name two methods of prophylaxis of preterm labour

A

Vaginal progesterone (if cervical length <25mm on TV US at 16-24 wks gestation)

Cervical cerclage
- Stitch in the cervix to add support

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10
Q

Define preterm prelabour rupture of membranes

A

Amniotic sac ruptures

Before the onset of labour

In a preterm pregnancy (<37 weeks gestation)

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11
Q

What is the management of P-PROM?

A

Prophylactic antibiotics to prevent chorioamnionitis

Induction of labour from 34 wks onwards

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12
Q

What is tocolysis in premature labour?

A

Medications to stop uterine contractions

e.g. Nifedipine

24-33+6 wks gestation

Only useful for 48 hours!

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13
Q

What medication is given to reduce RDS in neonates born prematurely?

A

Corticosteroids

Often two doses of IM betamethasone, 24 hours apart

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14
Q

When are corticosteroids given to prevent RDS in neonates?

A

< 36 weeks gestation

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15
Q

What medication is given IV to reduce the risk of cerebral palsy in infants born <34 weeks gestation?

A

IV magnesium sulphate

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16
Q

At what gestation is induction of labour offered?

A

41-42 weeks gestation

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17
Q

What scoring system is used to determine if labour should be induced?

A

Bishops score

> 8

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18
Q

Define membrane sweep

A

Induction of labour

Insert finger into the cervix to stimulate cervix and begin process of labour

If successful, can induce labour within 48 hours

Used from 40 weeks gestation

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19
Q

How does vaginal prostaglandin E2 work for IOL?

A

Gel/tablet/pessary PV

Slowly releases local prostaglandins over 24 hour

Stimulates cervix and uterus to cause onset of labour

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20
Q

How does artificial rupture of membranes work for IOL?

A

Oxytocin infusion

Often after vaginal prostaglandins have been used

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21
Q

Name two means for monitoring during IOL?

A

Cardiotocography to assess fetal heart rate and uterine contractions before/during labour

Bishop score to monitor progress

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22
Q

Define uterine hyperstimulation

A

Main complication of IOL with vaginal prostaglandins

Causes prolonged and frequent uterine contractions = fetal distress and compromise

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23
Q

What is major risk of uterine hyperstimulation?

A

Uterine rupture

Fetal compromise w/hypoxia and acidosis

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24
Q

What are the two management options for uterine hyperstimulation?

A

Remove PV prostaglandins or stop oxytocin infusion

Tocolysis with terbutaline

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25
Q

What is electronic fetal monitoring?

What does it measure?

A

Cardiotocophraphy

Fetal heart rate and uterine contractions

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26
Q

Define accelerations in relation to CTG

A

Periods of fetal HR spikes

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27
Q

Define deceleration in relation to CTG

A

Periods of fetal HR drops

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28
Q

What is “reassuring” for baseline rate and variability?

A

Baseline rate 110-160

Variability 5-25

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29
Q

Define early deceleration

A

Gradual reduction in HR
Corresponds w/uterine contractions
Not pathological

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30
Q

Define late decelerations

A

Gradual fall in HR
Start after uterine contraction
Lowest point of deceleration occurs after the peak of the contraction

Due to hypoxia e.g. excessive uterine contractions, maternal hypertension or maternal hypoxia

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31
Q

Define variable declerations

A

Abrupt deceleration
Can be unrelated to uterine contractions
Fall >15bpm from baseline

Due to intermittent compression of umbilical cord = fetal hypoxia

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32
Q

Define prolonged deceleratins

A

Last 2-10 minutes w/drop >15 bpm from baseline

Abnormal and concerning

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33
Q

What is the baseline rate for non-reassuring?

A

100-109

or

161-180

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34
Q

What is variability for non-reassuring?

A

< 5 for 30-50 mins

or

> 25 for 15-25 mins

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35
Q

What is abnormal baseline rate?

A

<100

or

> 180

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36
Q

What is abnormal variability?

A

<5 for over 50mins

or

> 25 over 25 mins

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37
Q

Define suspicious CTG

A

single non-reassuring abnormal feature

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38
Q

Define pathological CTG

A

two non-reassuring

or

single abnormal feature

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39
Q

Define need for urgent intervention

A

acute bradycardia

or

prolonged deceleration >3 minutes

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40
Q

What is the “rule of 3’s” for fetal bradycardia?

A

3 minutes = call for help

6 minutes = move to theatre

9 minutes = prepare for delivery

12 minutes = deliver the baby (in 15 mins!)

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41
Q

What is Dr C BRaVADO?

A 
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall impressions
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42
Q

How does oxytocin work?

A

Secreted by posterior pituitary gland

Ripens cervix
Uterine contractions

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43
Q

Atosiban

A

Oxytocin receptor antagonist for tocolysis

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44
Q

Ergometrine

A

Stimulates smooth muscle contraction

Third stage of labour, tx PPH

45
Q

Misoprostol

A

Prostaglandin analogue

Medical management of miscarriage

46
Q

Mifepristone

A

Anti-progestogen

Blocks progesterone action

47
Q

Nifedipine

A

Calcium channel blocker

Reduce BP in hypertension and pre-eclampsia

Tocolysis in premature labour

48
Q

Terbutaline

A

Beta 2 agonist

Tocolysis in uterine hyperstimulation

49
Q

Tranexamic Acid

A

Antifibrinolytic
Prevents fibrinogen to plasmin

Postpartum hemorrhage

50
Q

First Stage of Labour Phases?

A

Latent i.e. 0-3cm dilation, 0.5cm per hour

Active i.e. 3-7cm, 1cm per hour

Transition i.e. 7-10cm, 1cm per hour

51
Q

What is the criteria for delayed first stage of labour?

A

<2cm of cervical dilatation in 4 hours

Slowing of progress in multiparous women

52
Q

Partogram

A

Monitor progress in first stage of labour

53
Q

Second stage of labour?

A

10cm dilatation to delivery of baby

54
Q

Criteria for delay in 2nd stage of labour

A

2 hours in nulliparous

1 hour in multiparous

55
Q

What three things determine the second stage of labour?

A

Power
Passenger
Passage

56
Q

Define 3rd stage of labour

A

Delivery of baby to delivery of placenta

57
Q

Define delay in 3rd stage of labour

A

> 30 minutes with active management

> 60 minutes with physiological management

58
Q

What is involved in active management of third stage of labour?

A

IM oxytocin

Controlled cord traction

59
Q

What is the aim for number of contractions in those medically managed in failure to progress?

A

4-5 contractions per 10 minutes

60
Q

Define Entonox

A

50% nitrous oxide

50% oxygen

61
Q

Name the drug used in PCA for delivery

A

Remifentanil

62
Q

Management of umbilical cord prolapse

A

Emergency caesarean section

63
Q

Define shoulder dystocia

A

Anterior shoulder of baby becomes stuck behind the pubic symphasis

After the head has been delivered

Obstetric emergency

Often caused by macrosomia secondary to gestational diabetes

64
Q

Presentation of shoulder dystocia

A

Difficulty delivering face and head

Obstruction in delivering the shoulders after delivery of the head

65
Q

Episiotomy

A

Enlarges vaginal opening

Reduces risk of perineal tears

66
Q

McRoberts Manoeuvre

A

Bring knees up to abdomen

Posterior pelvic tilt

Lifts pubic symphysis out the way

67
Q

Zavanelli Manoeuvre

A

Push babys head back into vagina

Allow for emergency c section delivery

68
Q

Complications of should dystocia

A

Fetal hypoxia
Brachial plexus injury and Erb’s palsy
Perineal tears
Postpartum haemorrhage

69
Q

Name 4 indications for instrumental delivery

A

Failure to progress
Fetal distress
Maternal exhaustion
Control of the head in various fetal positions

70
Q

What 2 key risks are there to baby in instrumental delivery?

A

Cephalohaematoma (with a ventouse)

Facial nerve palsy (with forceps)

71
Q

Define ceaphalohaematoma

A

Collection of blood between the skull and periosteum

Complication of ventouse delivery

72
Q

Name two nerve injuries that may develop due to instrumental delivery in mum?

A

Femoral nerve = weakness of knee extension, loss of patella reflex and numbness

Obturator nerve = weakness in hip adduction/rotation

73
Q

Define first degree perineal tear

A

Limited to frenulum of labia minora

74
Q

Define second degree perineal tear

A

Perineal muscles

Not anal sphincter

75
Q

Define third degree perineal tear

A

Anal sphincter

Not rectal mucosa

76
Q

Define fourth degree perineal tear

A

involves rectal mucosa

77
Q

Management of second degree tears

A

Sutures

78
Q

Management of 3rd/4th degree tears

A

Surgical repair in theatre

79
Q

Name four short term complications of perineal tears

A

Pain
Infection
Bleeding
Wound dehiscence or breakdown

80
Q

Name three long term complications of perineal tears

A

Urinary incontinence

Anal incontinence

Sexual dysfunction

81
Q

Define episiotomy

A

45 degree cut in the perineum

Mediolateral to avoid anal sphincter

Sutured after delivery

82
Q

Define physiological management of third stage of labour

A

Placenta delivered by maternal effort

Without medications or cord traction

83
Q

Define active management of third stage of labour

A

HCP involved in delivery of placenta

IM oxytocin = uterine contraction

Cord traction = guide placenta out

Routinely offered to all women to reduce risk of PPH

84
Q

Name two indications of active management of third stage of labour

A

Haemorrhage

> 60 minutes delay in placental delivery

85
Q

Define PPH

A

Postpartum haemorrhage

Bleeding after delivery of baby and placenta

Commonest cause of significant obstetric haemorrhage

500ml after vaginal delivery
1000ml after caesarean section

86
Q

Define primary and secondary PPH

A

Primary = within 24 hours

Secondary = from 24hrs - 12wks postpartum

87
Q

Name the four “T’s” causing postpartum haemorrhage

A

Tone - uterine atony

Trauma e.g. perineal tear

Tissue e.g. retained placenta

Thrombin e.g. bleeding disorder

88
Q

Name three risk factors of postpartum haemorrhage

A

Previous PPH

Multiple pregnancies

Obesity

Large baby

89
Q

Name three methods to reduce risk/consequences of postpartum haemorrhage

A

Treating anaemia in antenatal period

Give birth with an empty bladder (full bladder reduces uterine contractions)

Active management of 3rd stage

IV tranexamic acid during c section in higher-risk pts

90
Q

Outline management of PPH

A 
ABCDE approach
Lie mum flat, keep her warm
2 large bore cannulas
Bloods e.g. FBC, U&Es, clotting screen
Group and cross match four units
Warmed IV fluids/blood resuscitation as required
Oxygen
91
Q

Outline mechanical methods for PPH

A

Rubbing the uterus through abdomen = stimulate uterine contraction

Catheterisation = empty bladder

92
Q

Outline Medical management of PPH

A

Oxytocin infusion

Ergometrine = stimulate smooth muscle contraction

Carbopost = prostaglandin analogue, stimulates uterine contraction (caution in asthma)

Tranexamic acid = antifibrinolytic

93
Q

Outline surgical management of PPH

A

Intrauterine balloon tamponade

B-lynch suture

Uterine artery ligation

Hysterectomy

94
Q

Name two causes of secondary PPH

A

Retained products of conception

Infection e.g. endometritis

95
Q

Define caesarean section

A

Surgical operation to deliver the baby via incision in the abdomen and uterus

Transverse lower uterine segment incision

96
Q

Name four risks of caesarean section

A

Infection - give prophylactic antibiotics during procedure

PPH - given oxytocin during

VTE - given LMWH e.g. enoxaparin

Pain

97
Q

Name two causes of shock in pregnancy

A

Chorioamnionitis

UTI

98
Q

Define MOEWS

A

Maternity Early Obstetric Warning System

99
Q

Name three signs of chorioamnionitis

A

Abdominal pain

Uterine Tenderness

Vaginal discharge

100
Q

What is involved in sepsis six?

A

Take three

  1. Blood lactate
  2. Blood cultures
  3. Urine output

Give three

  1. Oxygen
  2. Antibiotics
  3. IV fluids
101
Q

Define amniotic fluid embolism

A

Rare

Amniotic fluid passes into the mothers blood

Often around labour and delivery

Amniotic fluid contacts fetal tissue which causes an immune response

102
Q

Name two risk factors for amniotic fluid embolism

A

Increased maternal age

Induction of labour

103
Q

Overview of symptoms of amniotic fluid embolism

A

Similar to sepsis, pulmonary embolism or anaphylaxis

SOB/hypoxia/hypotension etc

104
Q

Management of amniotic fluid embolism

A

Supportive
A-E approach
ITU care

105
Q

Main risk factor for uterine rupture

A

Previous C section

106
Q

Key features of uterine rupture

A

Abdominal pain

PV bleeding

Ceasing of uterine contractions

Hypotension/collapse

107
Q

Management of uterine rupture

A

Obstetric emergency

Resuscitation and transfusion

Emergency c section

Stop bleeding

Hysterectomy

108
Q

Define Johnson manoeuvre

A

Reversal of uterine inversion

Use a hand to push fundus back into abdomen and correct position

Often involves inserting the whole forearm into the vagina

Obs and Gynae (5 decks)

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