Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 2 changes occur and what allows this

A

Cervical dilatation + effacement
Contractions
Progesterone decreases
Oxytocin and prostaglandin increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is plotted separately

A

If syntocin or epidural use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How often are contractions measured

A

Every 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is stage 1

A

0cm dilated - 10cm
Latent stage
Established

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is latent stage 1

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is established stage 1

A

Regular painful contractions

Brings dilatation to 10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How many contractions in established

A

3-4 every 10 minutes

Lasting 30-40s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you assess progress

A

Abdominal and vaginal examination

Every 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the typical times stage 1

A

8 hours prim

5 hours multi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is poor progress

A

<0.5cm-1cm per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is passive stage 2

A

Full dilatation -> expulsive contration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How long in passive

A

1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is active stage 2

A

Presenting part is visible

Active maternal effort and pushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long in active

A

1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should you consider if active >2 hours

A

Ventouse
Forceps = best
C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When would you allow longer

A

If had epidural as slows down contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are signs when in labour

A

Rhomboid of Michaelis - sacrum pushed out on skin

Anal cleft line - purple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is stage 3

A

Expulsion of placenta and membranes

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is physiological mamnegemt

A

No drugs
No clamping until pulsating stop
Maternal effort to delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What do you do if concerning CTG

A

Fetal scalp electrode

Fatal blood sampling to look at pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If acidosis shown what do you do

A

Emergency C-section

If BE increased suggests compensating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What do you monitor on MEWS

A 
Pulse
BP
RR
Temp
Sats
Urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does tachycardia suggest

A

Pain
Sepsis
Dehydration
Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does tachypnoea suggest

A

Acidosis
Sepsis
PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does high BP suggest

A

New PET

Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does low BP suggest

A

Blood loss

Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should you look at when liquor passed

A

Colour - should be straw
Smell
Volume
Meconium if baby poos as distressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What do you feel for in abdominal exam

A

Contraction
Presentation - cephalic / breech
Lie - transverse / longitudinal / oblique
Engagement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What do you feel for in VE

A 
Dilatation
Effacement 
Fetal station -
Fetal position 
Fetal altitude - flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does fetal station show

A 
0 = engaged at level of ischial spine 
-3 = 3 above ischial spine 
3+ = 3 below
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What position do you want baby in

A

ROA or LOA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What do you do if baby OP

A

Longer and more painful delivery
Augmentation if slow
Forceps > ventouse
May need to rotate in theatre to OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is Lochia

A

Vaginal discharge after birth
Like a period
Normal for 4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the Apgar score

A

Physical state of infant 1 minute and 5 minutes + 10 after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does Apgar look at

A 
RR
HR
Colour
Tone
Reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What score is normal and abnormal

A

> 7 =.normal

0-3 = very poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What medication after labour

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What does haemorrhagic disease present like

A

Bruising
Kidney necroiss
IVH

Anti-coagulant and breast feeding increase risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What diseases in neonatal blood spot - day 5-9

A 
Sickle cell
Thalassemia
Tay-Sachs
CF
PKU
Congenital hypothyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Complications of labour

A 
Slow progress
Meconium aspiration
Pyrexia
Abnormal CTG
APH
PPH
46
Q

What is a C-section indicated

A 
Cephalic disproportion
Malpresentation - ALL BREECH / transverse 
Placnta praevia / uterine rupture 
Fetus not engaged
2x previous C-section
Uncontrolled HIV 
If abnormal CTG
47
Q

What are relative indications

A 
PET
Post date
IUGR
Distress
Failure to progress
Abruption
Infection
Cervical cancer
48
Q

What is most common C-section

  • Anaesthetic
  • What is given after
A

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
Q

When is VBAC recommended and when is it CI

A

Always

Unless classic C-section scar or uterine rupture or praaevia

50
Q

What is indications for forceps

A 
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
Q

What are risks to mother of C-section

A 
Hysterectomy
VTE
Bladder / ureteric injury
Haemorrhage 
Increased rupture / pravia risk in future pregnancy
Wound infection
Endometritis
UTI
Subfertility due to adhesion
Ileus 
Death
52
Q

What are risks to foetus

A

Laceration
Facial nerve palsy
Cephalohaematoma if ventouse

53
Q

What causes ROPC

A

Uterus does not contract well as products still in cavity

54
Q

Wha are symptoms of ROPC

A 
Pain
Heavy bleeding
Discharge
Offensive if infected
Poorly contracted uterus
55
Q

Higher risk of RPOC

A

C-section

56
Q

How do you Dx

A

EUA

Speculum to see if os open or closed

57
Q

How do you treat

A

Remove under anasthesia

Iv Ax

58
Q

What are causes of failed 1st or 2nd stage

A 
Inadequate uterine activity
Cephalopelvic disproportion
Malposition
Cervical dystocia
Cerivcal Rx
Obstruction
Distress
59
Q

What are causes of failed 3rd stage

A

Placenta doesn’t detach
Cervix starts to close
Placenta accretia

60
Q

When should you NOT induce

A 
Obstruction e.g. praaevia as induction can cause rupture 
Malpresentation
Asthma - prostaglandins
Complication
Fetal condition / distress /
Abnormal CTG
61
Q

What are 3P’s

A

Power
Passage
Position - OP

62
Q

What are indications for induction

A 
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
Q

What is Bishops score

A

Assess whether induction is required or if spontaneous labour will occur
- Assess station, cervical dilatation, effacement + position
<5 = unlikely spontaneous
>9 = spontaneous

64
Q

What does CTG do

A

Monitor contraction and fatal HR

65
Q

What is likely cause of foetus not engaged

A

Malpositoin

DIsproportion of size

66
Q

If not engaged wat is needed

A

C-section

67
Q

If foetus engaged

A

Forceps if not progressing

May need to rotate

68
Q

How do you attempt to start labour

A

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
Q

What score before amniotomy

A

Bishops >7

70
Q

If high risk after delivery what do you get

A 
15 minute obs
Ensure no abnormal bleeding
Ensure uterus contracted
Ax
VTE
71
Q

What does assisted delivery need

A

Full dilatation

72
Q

When are C-sections essential

A

Obstructed / distress

Not fully dilated

73
Q

Where do you want placenta

A

Posterior as cutting anteriorly

74
Q

Complications of induction

A 
Higher chance of instrumental / CS
Less efficient 
More painful
Anasthesia 
Fetus distress = CTG 
Hyperstimulation
75
Q

What is normal post partum

A

Midwife
HV
Observe for bleeding / infection
Infant bonding / social issues

76
Q

Relationship between oxytocin and oliguria

A

Produced in PP
Same place as where ADH produced
Small ADH effect
Cause oedema and marked diuresis after delivery

77
Q

When do you do continuous CTG

A 
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
Q

How do you read CTG

A

DR C BRAVADO

79
Q

DR

A

Define risk

If high risk pregnancy = lower threshold

80
Q

C

A

Contraction
How many
Duration
Intensity

81
Q

BRA

A

Baseline rate
Average in 10 minutes
Ignore accelerations
110-160 normal

82
Q

What does Brady suggest

A

Maternal BB
Cord prolapse
Hypoxia
Increased vagal tone

83
Q

What does tachy suggest

A

Maternal pyrexia
Chorioamnitis
Hypoxia
Premature

84
Q

V

A

Variability
Want 5-25BPM - shows intact near changing to environment
If poor >40 minutes = bad

85
Q

What does poor variability suggest

A 
Premature
Hypoxia
Acidosis
Benzo / opioids
Congenital heart
Sleeping
86
Q

A

A

Acceleration
Reassuring
Occur with contraction

87
Q

D

A 
Deceleration
If with contraction + resolve by end = fine 
If persistent = close monitor 
Shallow = worry
if late = fatal blood sample
88
Q

What does late deceleration suggest

A

Distress
Asphyxia
Placental insufficiency
Usually need emergency C-section and senior review but get foetal blood sampling if no condition

89
Q

What does early suggest

A

Head compression

90
Q

What does variable suggests

A

Cord compression

91
Q

O

A

Overall impression

  • Reassuring
  • Suspicious
  • Abnormal
92
Q

What is needed before assisted delivery

A 
F –fully dilated cervix
O – OA but oP possible 
R – ruptured membrane
C – cephalic
E – engaged
P – painrelief
S – sphincter empty ( catheter)
93
Q

What is associated with high mortality if breech

A

Footing

94
Q

What increases risk of breech

A 
Uterine malformation / fibroid
Praevia
Poly or oligohyramnios
Premature 
Fetal abnormality
95
Q

What do you do if breech and <36 weeks

A

Resolve spontaneously

96
Q

What would you do if breech and >36 weeks

A

External cephalic version

- Applying pressure on the abdomen to try turn the baby

97
Q

What do you do if ECV doesn’t work and when would you require C-section

A 
Discuss options for vaginal birth or C-section
C- section safer 
Footling birth - feet below bottom
SGA or LGA
Placenta praevia
PET
98
Q

What is CI to ECV

A 
If C-section required
Abnormal CTG
APH
Major uterine anomaly 
Ruptured membrane
Multiple babies
99
Q

What are complications of breech / transverse

A

Cord prolapse

DDH

100
Q

If breech and in labour what do you do

A

C-section

Breech extraction is difficult

101
Q

What is used if failure to progress

A

IV syncotin to stimulate contractions

Want 4 in 10 minutes

102
Q

What are complications of C-section

A 
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
Q

What are complications for baby

A

Laceration

TTN

104
Q

What happens after birth

A 
Vit K to baby
Skin to skin contact
Initiate breast
Newborn exam within 24 hours
Neonatal blood spot
Newborn hearing
105
Q

Complications of traumatic labour to baby

A 
Cephalohaematoma 
Facial paralysis
Erb's
Fractured clavicle 
Lacerations
106
Q

How does fractured clavicle present

A 
Dx on baby exam
Asymmetry 
Lack of movement 
Pain and distress
Dx on USS / X-ray
107
Q

How do you treat

A

Immobilisation

108
Q

What features on CTG need senior review / foetal blood sampling

A

1+ abnormal

109
Q

What features require C-section

A

Bradycardia

Single prolonged deceleration >3 minutes

110
Q

What are conservative measures in meantime

A

Increase fluid

Move to left lateral

Obs & Gynae (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions