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OBGYN > Labour & Delivery > Flashcards

Labour & Delivery Flashcards

1
Q

When does labour & delivery normally occur

A

37 - 42 weeks

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2
Q

What happens during the 1st stage of labour

A

Cervical dilation up to 10cm
Effacement
Contractions

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3
Q

3 phases of the 1st stage of labour

A

Latent phase - Up to 3cm dilation, 0.5cm per hour, Irregular contractions
Active phase - 3cm to 7cm dilation, 1cm per hour, Regular contractions
Transition phase - 7cm to 10cm dilation, 1cm, strong regular contractions

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4
Q

Signs of labour

A

Show
Rupture of membranes
Regular painful contractions
Dilating cervix

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5
Q

Prophylaxis of preterm labour

A

Vaginal progesterone
Cervical cerclage

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6
Q

Premature rupture of membranes diagnosis

A

Speculum exam - Pooling of amniotic fluid in vagina
Fluid tests - IGFBP-1, PAMG-1

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7
Q

Management of premature rupture of membranes

A

Prophylactic erythromycin (prevent chorioamnionitis)
Induction of labour at 34 weeks

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8
Q

Management of preterm labour

A

Fetal monitoring
Tocolysis with nifedipine
Maternal corticosteroids if before 35 weeks
IV magnesium sulphate if before 34 weeks
Delayed cord clamping

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9
Q

What corticosteroid is used in preterm labour

A

IM betamethasone

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10
Q

Indications for induction of labour

A

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death

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11
Q

What scoring system determines whether to induce labour

A

Bishop Score

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12
Q

What factors make up the Bishop score

A

Fetal station
Cervical position
Cervical dilatation
Cervical effacement
Cervical consistency

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13
Q

Options for induction of labour

A

Membrane sweep - from 40 weeks
Vaginal prostaglandin E2
Cervical ripening balloon - previous c section, failed prostaglandins
Oxytocin infusion

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14
Q

Criteria for uterine hyperstimulation

A

Contractions lasting longer than 2 minutes
More than 5 contractions in 10 minutes

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15
Q

Management of uterine hyperstimulation

A

Removing vaginal prostaglandins
Halting oxytocin
Tocolysis with terbutaline

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16
Q

What are oxytocin infusions used for

A

Induce labour
Progress labour
Improve frequency & strength of uterine contractions
Prevent/treat postpartum haemorrhage

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17
Q

What is ergometrine used for

A

Delivery of the placenta
Reduce & treat postpartum haemorrhage during 3rd stage of labour

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18
Q

What is carboprost used for

A

To treat postpartum haemorrhage when ergometrine & oxytocin have been inadequate
Caution in asthma

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19
Q

When is the 1st stage of labour considered delayed

A

<2cm dilatation in 4hrs
Slowing of progress in multiparous women

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20
Q

What is the 2nd stage of labour

A

10cm cervical dilatation to delivery of the baby

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21
Q

When is the 2nd stage of labour considered delayed

A

Active stage lasting:
-2 hrs in nulliparous
-1 hr in multiparous

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22
Q

Types of fetal lie

A

Longitudinal lie
Transverse lie
Oblique lie

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23
Q

What is the 3rd stage of labour

A

Delivery of the baby to delivery of the placenta

24
Q

When is the 3rd stage of labour considered delayed

A

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

25
Q

Management of failure to progress

A

Artificial rupture of membranes
Oxytocin
Instrumental delivery
Caesarean section

26
Q

Non-medical options for discomfort during labour

A

Relaxed environment
Changing position
Controlled breathing
Water birth
TENS machine

27
Q

Pain management options during labour

A

Paracetamol
Codeine
Entonox
IM Pethidine
Remifentanil
Epidural - Bupivacaine + fentanyl

28
Q

Adverse effects of epidural

A

Headache after insertion
Hypotension
Motor weakness in the legs
Nerve damage
Prolonged 2nd stage
Increased probability of instrumental delivery

29
Q

Most significant risk in umbilical cord prolapse

A

Fetal hypoxia

30
Q

Management of umbilical cord prolapse

A

Emergency C section
Keep cord warm & wet
DO NOT push cord back
Lie in left lateral position
Tocolytics whilst waiting for theatre

31
Q

What is shoulder dystocia

A

Anterior shoulder of baby gets stuck behind the pubic symphysis after delivery of the head

32
Q

Characteristic sign of shoulder dystocia

A

Turtle-neck sign

33
Q

Management of shoulder dystocia

A

Seek senior help including anaesthetist & paediatrician
Episiotomy
McRoberts manoeuvre
Pressure to anterior shoulder by pressing on suprapubic region

34
Q

Complications of shoulder dystocia

A

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

35
Q

Indications for instrumental delivery

A

Failure to progress
Fetal distress
Maternal exhaustion
To control the head

36
Q

Risks of instrumental delivery

A

Postpartum haemorrhage
Episiotomy
Perineal tears
Injury to anal sphincter
Incontinence
Injury to obturator or femoral nerve

37
Q

Risks of instrumental delivery to baby

A

Cephalohaematoma (ventouse)
Facial nerve palsy (forceps)
Subgaleal haemorrhage
Intracranial haemorrhage
Skull fracture
Spinal cord injury

38
Q

Risk factors for perineal tears

A

First birth
Large babies
Shoulder dystocia
Asian ethnicity
Occipito-posterior position
Instrumental deliveries

39
Q

1st degree perineal tears

A

Injury limited to frenulum of labia minora & superficial skin

40
Q

2nd degree perineal tear

A

Includes perineal muscles but not the anal sphincter

41
Q

3rd degree perineal tears

A

3a - <50% of external anal sphincter
3b - >50% of external anal sphincter
3c - affects both internal & external anal sphincters

42
Q

4th degree perineal tear

A

Includes rectal mucosa

43
Q

Complications of perineal tears

A

Pain
Infection
Bleeding
Wound dehiscence
Urinary incontinence
Anal incontinence
Fistula between vagina & bowel
Sexual dysfunction
Psychological consequences

44
Q

Steps in active management of 3rd stage

A

IM oxytocin after delivery
Cord clamped & cut within 5 mins
Controlled cord traction during contraction
Aim to deliver in one piece

45
Q

What is classified as postpartum haemorrhage

A

500ml loss after vaginal delivery
1000ml loss after C section

46
Q

Causes of postpartum haemorrhage

A

Uterine atony
Trauma
Retained placenta
Bleeding disorders

47
Q

Risk factors for postpartum haemorrhage

A

Previous PPH
Multiple pregnancy
Obesity
Large baby
Failure to progress in 2nd stage
Prolonged 3rd stage
Pre-eclampsia
Placenta praevia
Placenta accreta
Retained placenta
Instrumental delivery

48
Q

Stopping bleeding during postpartum haemorrhage

A

Rubbing the uterus
Catheterisation
Oxytocin
Ergometrine
Carboprost
Tranexamic acid
Intrauterine balloon tamponade
Uterine artery ligation
Hysterectomy

49
Q

What causes secondary postpartum haemorrhage

A

Retained products of conception
Infection

50
Q

Key causes of maternal sepsis

A

Chorioamnionitis
UTI

51
Q

Risk factors for amniotic fluid embolism

A

Increasing maternal age
Induction of labour
C section
Multiple pregnancy

52
Q

Presentation of amniotic fluid embolism

A

SOB
Hypoxia
Hypotension
Coagulopathy
Haemorrhage
Tachycardia
Confusion
Seizures
Cardiac arrest

53
Q

Risk factors for uterine rupture

A

Previous C section
VBAC
Previous uterine surgery
Increased BMI
High parity
Increased age
Induction of labour
Use of oxytocin

54
Q

Presentation of uterine rupture

A

Abnormal CTG
Abdominal pain
Vaginal bleeding
Ceasing of uterine contractions
Hypotension
Tachycardia
Collapse

55
Q

Management of uterine rupture

A

Emergency C section
Repair uterus/hysterectomy

OBGYN (5 decks)

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