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Obs & Gynae > Labour - Normal and Failure to Start > Flashcards

Labour - Normal and Failure to Start Flashcards

1
Q

What is normal labour and what signs suggest

A 
Spontaneous 
37-42 weeks
Show (mucous plug) 
Rupture of membrane
Regular painful contractions
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2
Q

What 2 changes occur and what allows this

A

Cervical dilatation + effacement
Contractions
Progesterone decreases
Oxytocin and prostaglandin increase

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3
Q

What does a partogram monitor

A 
Fetal HR
Cervical dilatation
Contractions - duration and strength
Maternal BP
Maternal pulse 
Urine output
Temperature
Medication given
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4
Q

What is plotted separately

A

If syntocin or epidural use

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5
Q

How often are contractions measured

A

Every 10 minutes

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6
Q

What is stage 1

A

0cm dilated - 10cm
Latent stage
Established

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7
Q

What is latent stage 1

A

Irregular painful contractions
Cervical effacement (thin and short)
Dilatation to 3cm

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8
Q

What is established stage 1

A

Regular painful contractions

Brings dilatation to 10cm

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9
Q

How many contractions in established

A

3-4 every 10 minutes

Lasting 30-40s

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10
Q

How do you assess progress

A

Abdominal and vaginal examination

Every 4 hours

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11
Q

What are the typical times stage 1

A

8 hours prim

5 hours multi

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12
Q

What is poor progress

A

<0.5cm-1cm per hour

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13
Q

What is passive stage 2

A

Full dilatation -> expulsive contration

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14
Q

How long in passive

A

1 hour

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15
Q

What is active stage 2

A

Presenting part is visible

Active maternal effort and pushing

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16
Q

How long in active

A

1-2 hours

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17
Q

What should you consider if active >2 hours

A

Ventouse
Forceps = best
C-section

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18
Q

When would you allow longer

A

If had epidural as slows down contractions

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19
Q

What are signs when in labour

A

Rhomboid of Michaelis - sacrum pushed out on skin

Anal cleft line - purple

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20
Q

What is stage 3

A

Expulsion of placenta and membranes

Membrane will rupture spontaneous or with a hook then placenta folds in

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21
Q

What is active management of stage 3

A

Empty bladder
Ureotonic drugs to get uterus to contract
- IM syntocin
Early clamping and cutting of cord - within 1 minute
Controlled cord traction to get placenta out

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22
Q

What is physiological mamnegemt

A

No drugs
No clamping until pulsating stop
Maternal effort to delivery

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23
Q

How long do you allow for physiological management

A

60 minutes

Only do if very low risk of PPH - active better to reduce the risk

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24
Q

How often should a foetus be monitored in each stage / fill in cartogram

A

15 minutes stage 1
5 minutes stage 2
Ausculate heart with special stethoscope
Continuous with CTG if any concern + partogram 30 minutes

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25
What do you do if concerning CTG
Fetal scalp electrode | Fatal blood sampling to look at pH
26
If acidosis shown what do you do
Emergency C-section | If BE increased suggests compensating
27
What do you monitor on MEWS
``` Pulse BP RR Temp Sats Urine output ```
28
What does tachycardia suggest
Pain Sepsis Dehydration Bleeding
29
What does tachypnoea suggest
Acidosis Sepsis PE
30
What does high BP suggest
New PET | Pain
31
What does low BP suggest
Blood loss | Shock
32
What should you look at when liquor passed
Colour - should be straw Smell Volume Meconium if baby poos as distressed
33
What do you feel for in abdominal exam
Contraction Presentation - cephalic / breech Lie - transverse / longitudinal / oblique Engagement
34
What do you feel for in VE
``` Dilatation Effacement Fetal station - Fetal position Fetal altitude - flexion ```
35
What does fetal station show
``` 0 = engaged at level of ischial spine -3 = 3 above ischial spine 3+ = 3 below ```
36
What position do you want baby in
ROA or LOA
37
What do you do if baby OP
Longer and more painful delivery Augmentation if slow Forceps > ventouse May need to rotate in theatre to OA
38
What is Lochia
Vaginal discharge after birth Like a period Normal for 4-6 weeks
39
What is the Apgar score
Physical state of infant 1 minute and 5 minutes + 10 after birth
40
What does Apgar look at
``` RR HR Colour Tone Reflexes ```
41
What score is normal and abnormal
>7 =.normal | 0-3 = very poor
42
What medication after labour
Vit K to baby to prevent haemorrhagic disease VTE prophylaxis to mother Ergometrine to help deliver placenta (not if raised BP) Syntometrine (oxytocin + ergometrine) - more effective Oxytocin alone if high BP
43
What does haemorrhagic disease present like
Bruising Kidney necroiss IVH Anti-coagulant and breast feeding increase risk
44
What diseases in neonatal blood spot - day 5-9
``` Sickle cell Thalassemia Tay-Sachs CF PKU Congenital hypothyroid ```
45
Complications of labour
``` Slow progress Meconium aspiration Pyrexia Abnormal CTG APH PPH ```
46
What is a C-section indicated
``` Cephalic disproportion Malpresentation - ALL BREECH / transverse Placnta praevia / uterine rupture Fetus not engaged 2x previous C-section Uncontrolled HIV If abnormal CTG ```
47
What are relative indications
``` PET Post date IUGR Distress Failure to progress Abruption Infection Cervical cancer ```
48
What is most common C-section - Anaesthetic - What is given after
Low segment Upper = higher risk of rupture Usually done with spinal as less risk than general Require TED stockings after and LMWH for 10 days if emergency
49
When is VBAC recommended and when is it CI
Always | Unless classic C-section scar or uterine rupture or praaevia
50
What is indications for forceps
``` Engaged foetus - can't do if not fully engaged and dilated Fetal or maternal distress in 2nd stage Failure to progress in 2nd stage Control of head in breech Rotate OP ```
51
What are risks to mother of C-section
``` Hysterectomy VTE Bladder / ureteric injury Haemorrhage Increased rupture / pravia risk in future pregnancy Wound infection Endometritis UTI Subfertility due to adhesion Ileus Death ```
52
What are risks to foetus
Laceration Facial nerve palsy Cephalohaematoma if ventouse
53
What causes ROPC
Uterus does not contract well as products still in cavity
54
Wha are symptoms of ROPC
``` Pain Heavy bleeding Discharge Offensive if infected Poorly contracted uterus ```
55
Higher risk of RPOC
C-section
56
How do you Dx
EUA | Speculum to see if os open or closed
57
How do you treat
Remove under anasthesia | Iv Ax
58
What are causes of failed 1st or 2nd stage
``` Inadequate uterine activity Cephalopelvic disproportion Malposition Cervical dystocia Cerivcal Rx Obstruction Distress ```
59
What are causes of failed 3rd stage
Placenta doesn't detach Cervix starts to close Placenta accretia
60
When should you NOT induce
``` Obstruction e.g. praaevia as induction can cause rupture Malpresentation Asthma - prostaglandins Complication Fetal condition / distress / Abnormal CTG ```
61
What are 3P's
Power Passage Position - OP
62
What are indications for induction
``` DM / macrosomia 7+ days term Bishops <5 CI C-section Maternal health - PET / cancer Rhesus incompatbility Reduced foetal movement Growth concern Oligohydramnio Maternal request Social Pain PPROM Twins ```
63
What is Bishops score
Assess whether induction is required or if spontaneous labour will occur - Assess station, cervical dilatation, effacement + position <5 = unlikely spontaneous >9 = spontaneous
64
What does CTG do
Monitor contraction and fatal HR
65
What is likely cause of foetus not engaged
Malpositoin | DIsproportion of size
66
If not engaged wat is needed
C-section
67
If foetus engaged
Forceps if not progressing | May need to rotate
68
How do you attempt to start labour
Vaginal prostaglandin pessary if cervix not dilated Membrane sweep 2nd line Amniotomy IV oxytocin after amniotomy to achieve contraction after amniotomy or if poor progress Balloon catheter
69
What score before amniotomy
Bishops >7
70
If high risk after delivery what do you get
``` 15 minute obs Ensure no abnormal bleeding Ensure uterus contracted Ax VTE ```
71
What does assisted delivery need
Full dilatation
72
When are C-sections essential
Obstructed / distress | Not fully dilated
73
Where do you want placenta
Posterior as cutting anteriorly
74
Complications of induction
``` Higher chance of instrumental / CS Less efficient More painful Anasthesia Fetus distress = CTG Hyperstimulation ```
75
What is normal post partum
Midwife HV Observe for bleeding / infection Infant bonding / social issues
76
Relationship between oxytocin and oliguria
Produced in PP Same place as where ADH produced Small ADH effect Cause oedema and marked diuresis after delivery
77
When do you do continuous CTG
``` Risk of hypoxia Suspect sepsis Severe hypertension / PET APH Post date Induction Epidural Oxytocin use Prolonged labour Meconium passed Fresh vaginal bleed - sign of PPH Fetal distress Medical conditions ```
78
How do you read CTG
DR C BRAVADO
79
DR
Define risk | If high risk pregnancy = lower threshold
80
C
Contraction How many Duration Intensity
81
BRA
Baseline rate Average in 10 minutes Ignore accelerations 110-160 normal
82
What does Brady suggest
Maternal BB Cord prolapse Hypoxia Increased vagal tone
83
What does tachy suggest
Maternal pyrexia Chorioamnitis Hypoxia Premature
84
V
Variability Want 5-25BPM - shows intact near changing to environment If poor >40 minutes = bad
85
What does poor variability suggest
``` Premature Hypoxia Acidosis Benzo / opioids Congenital heart Sleeping ```
86
A
Acceleration Reassuring Occur with contraction
87
D
``` Deceleration If with contraction + resolve by end = fine If persistent = close monitor Shallow = worry if late = fatal blood sample ```
88
What does late deceleration suggest
Distress Asphyxia Placental insufficiency Usually need emergency C-section and senior review but get foetal blood sampling if no condition
89
What does early suggest
Head compression
90
What does variable suggests
Cord compression
91
O
Overall impression - Reassuring - Suspicious - Abnormal
92
What is needed before assisted delivery
``` F –fully dilated cervix O – OA but oP possible R – ruptured membrane C – cephalic E – engaged P – painrelief S – sphincter empty ( catheter) ```
93
What is associated with high mortality if breech
Footing
94
What increases risk of breech
``` Uterine malformation / fibroid Praevia Poly or oligohyramnios Premature Fetal abnormality ```
95
What do you do if breech and <36 weeks
Resolve spontaneously
96
What would you do if breech and >36 weeks
External cephalic version | - Applying pressure on the abdomen to try turn the baby
97
What do you do if ECV doesn't work and when would you require C-section
``` Discuss options for vaginal birth or C-section C- section safer Footling birth - feet below bottom SGA or LGA Placenta praevia PET ```
98
What is CI to ECV
``` If C-section required Abnormal CTG APH Major uterine anomaly Ruptured membrane Multiple babies ```
99
What are complications of breech / transverse
Cord prolapse | DDH
100
If breech and in labour what do you do
C-section | Breech extraction is difficult
101
What is used if failure to progress
IV syncotin to stimulate contractions | Want 4 in 10 minutes
102
What are complications of C-section
``` Anaesthetic risk General - bleeding, pain, infection, VTE Damage to local structures Adhesions Hernia Increased risk of C-section, uterine rupture, praevia and still birth ```
103
What are complications for baby
Laceration | TTN
104
What happens after birth
``` Vit K to baby Skin to skin contact Initiate breast Newborn exam within 24 hours Neonatal blood spot Newborn hearing ```
105
Complications of traumatic labour to baby
``` Cephalohaematoma Facial paralysis Erb's Fractured clavicle Lacerations ```
106
How does fractured clavicle present
``` Dx on baby exam Asymmetry Lack of movement Pain and distress Dx on USS / X-ray ```
107
How do you treat
Immobilisation
108
What features on CTG need senior review / foetal blood sampling
1+ abnormal
109
What features require C-section
Bradycardia | Single prolonged deceleration >3 minutes
110
What are conservative measures in meantime
Increase fluid | Move to left lateral

Obs & Gynae (23 decks)

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