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Obestetrics > Labour: Normal and Abnormal > Flashcards

Labour: Normal and Abnormal Flashcards

1
Q

Summary of Mx of first stage of labour

A 
From Dx labour to full dilatation of cervix
1 to 1 midwife
Obs + anaes as required
Monitor well being
4hrly PV exam (or as indicated)
Partogram
Pain relief
Hydration and light diet
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2
Q

Dx labour

A

regular painful contractions

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3
Q

Latent phase of labour

A

usually silent gradual cervical effacement
days/weeks
encourage mobilisation
Do not admit
Stand up
antacids if opiate analgesia
malpresentation: slower first stage and slow dilatation of cervix, may not go into labour at all

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4
Q

PV exams in First stage````

A 
every 4h
to determine if in active labour
More if concerns about progress or well being
normal prog: 1cm/2h
Record descending part
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5
Q

Mx of Second stage of labour

A 
First sign: urge to push
Full dilatation confirmed PV
Expulsive reflex
Discourage (semi)supine
Increase monitoring
Regional anaesthesia means Dx often made on PV
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6
Q

Prolonged second stage of labour

A 
Nulip. 3+ hrs from onset of second stage
Multip. 2+ hrs since active second stage
ARM if membranes intact
Consider oxytocin
Review every 15-30m
If having epidural allow extra hour
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7
Q

Descent and delivery of the Head

A

watch the perineum
Between contractions elastic tone will push head back into pelvis
when the head no longer recedes: crowning

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8
Q

Once crowning

A

Delivery is imminent
Guard perineum
discourage bearing down take rapid slow breaths

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9
Q

Immediate care of the neonate

A 
Should breathe within a couple seconds
No need for immediate clamping
Dependent holding to drain resp. mucous
Skin-skin (bonding and uterine cont.)
Dry and cover
Bf within 1hr
Routine measurements
Vit K first dose asap
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10
Q

Apgar performed

A

1m after cord clamping and again at 5min

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11
Q

Routine neonatal measurements

A

HC, birthweight, temperature

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12
Q

Managment of Third stage of labour

A

usually takes 5-10min

can be active or physiological

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13
Q

Active third stage Mx

A

All women recommended
10 IU oxytocin IM at birth of anterior shoulder or immediately after delivery (before cord clamped)
Use controlled cord traction to remove placenta (98% effective) if no bleed try again in 10min``

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14
Q

When to clamp cord

A

1-5min

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15
Q

Signs of placetal seperation

A

gush of blood
cord lengthening
Uterus rise or become round

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16
Q

Cx of third stage of labour

A

uterine inverion but is rare

17
Q

Physiological Mx of 3rd stage labour

A

Maternal effort controls delivery
heavier bleeding
if haem. OR placenta undel, after 60min recommend active Mx

18
Q

After completing third stage of labour

A

inspect placenta for missing cotyledons or succenturiate lobe
(if sus. examination under anaesthetic and MROP arranged)

19
Q

Induction of labour indications:

A
  1. Prevention of prolonged preg (uncomp. 41-42w, if declined 2/wk USS+CTG)
  2. PTL/ROM (avoid before 34w)
  3. Prev C-sec
  4. Maternal req. (exceptional circumstances around 40w)
  5. Breech (not recom. consider if ECV if declined and declines c-sec)
  6. IUGR (if sev. c-sec)
  7. IUD (if ROM, infection or bleed, mifepristone then misoprostol)
  8. DO NOT CARRY OUT INDUCTION FOR Macrosomia
20
Q

When to consider prostin/propress in cases where you might want to induce labour

A

PPROM

prev. c sec ( will increase risk of rupture and emergency c-sec

21
Q

Methods of inducing labour

A 
membrane sweep (offered prior to formal induction NOT official inducing labour 
Prostin or propress
ARM, Syntocinion, mechanical (not first line)
22
Q

When to offer membrane sweep

A

before formal induc
40-41wk (41 for parous F)
additional sweep if labour doesn’t start

23
Q

Prostin or propress

A 
PV PgE2
preferred induction method
PO (2 dose 6hrs aprt), gel, pessary(2 dose 6hrs apart) (1 dose/24hr)
RiskL uterine hyperstim
(if IUD misoprostol and mifepristone)
24
Q

Summary of induction of labour

A
  1. propress (24hr)
  2. Prostin if insuf. 6hrly
    3, ARM
    4, Syntocinon
    c-sec if all else fails
    if fully dilated offer instrumental delivery
25
Q

when to NOT induce

A

foetal head high (cord prolapse risk)

Obestetrics (21 decks)

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