Brainscape's Knowledge GenomeTM

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


See full index

Obs & Gynae > Labour problems > Flashcards

Labour problems Flashcards

1
Q

Problems with power and failure to progress in labour

A

Inefficient uterine action

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

Normal uterine contraction rate

A

45-60 second long contractions every 2-3 minutes in active labour. During delivery can slow to 60-90sec duration every 3-5mins

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

Mums likely to have Inefficient uterine action

A

Nulliparous

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

Management of Inefficient uterine action at different labour stages

A

1st stage = Augmentation via artificial rupture of membranes/amniotomy or oxytocin infusion. Exclude malpresentation!
2nd stage passive = nulliparous women given oxytocin infusion if delayed by 2hrs.
2nd stage active = if delay over 1hr consider episiotomy or instrumental delivery depending on fetal position.

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

Adverse effects of augmentation of labour

A

Hyperactive uterine action, fetal distress, increase risk of uterine rupture of previous C/S

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

Contraindications for augmentation in prolonged labour

A 
Placenta or vasa previa
Umbilical cord presentation
Prior classical uterine incision
Active genital herpes infection
Pelvic structural deformities
Invasive cervical cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Problems with passage and failure to progress in labour

A

Obstruction from abnomral pelvic architecture, pelvic mass (fibroid or tumour), cephalo-pelvic disproportion.

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

Causes of an abnormal pelvic architecture

A

Rickets, osteomalacia, spinal abnormality (scoliosis), polio

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

Problems with passenger and failure to progress in labour

A

Macrosomia
Poor presentation (breech, occiput-posterior, brow, occiput-transverse, face)
Fetal hydrocephalus.

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

Bishops Score

A

Less than 5 = labour unlikely to happen without intervention.
Over 5= labour will occur spontaneously.
Comprised of = Cervical dilation, length of cervix, station of head above ischial spines, cervical consistency, position of cervix.

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

Methods for inducing labour

A

Membrane sweep - releases prostaglandins and separates the amniotic membranes from the walls of the cervix.
Vaginal PGE2
Amniotomy plus/minus oxytocin.

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

Use of prostaglandin gel

A

Tablet or gel - Can give 2nd dose after 6hrs but subsequent ones not useful.
Pessary release - one over 24hrs.
Assess Bishop score after 6hrs.

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

Surgical methods for inducing labour

A

Amniotomy, add oxytocin infusion if no progress after 2hrs.

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

Examples of indications for inducing labour

A

Prolonged pregnancy (over42weeks), IUGR, antepartum haemorrrhage, preterm rupture of membranes, pre-eclampsia, gestational diabetes, in-utero death.

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

Cord prolapse definition

A

umbilical cord descends before fetus.

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

Complications of cord prolapse

A

Compression of cord and cord spasms
Fetal hypoxia
Cerebral palsy and irreversible fetal damage - death.

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

Risk factors for cord prolapse

A

Premature, breech presentation, abnormal lie, polyhydramnios, multiple pregnancy esp not the first baby delivered, placenta praevia, artificial rupture of membranes.

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

Clinical features of cord prolapse

A

No features in mum, unless see or feel prolapsed cord.

Fetus will have bradycardia.

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

Investigations and management of cord prolapse

A

Vaginal examination

DELIVER THE BABY - c-section ASAP, try not to handle cord too much but could push back to avoid compression.

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

Shoulder dystocia definition

A

Failure for the anterior shoulder to pass under the symphysis pubis after delivery of the fetal head that requires specific manoeuvres to facilitate delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk factors for shoulder dystocia

A 
Previous history
Macrosomia
DM
High maternal BMI
Induction of labour
Prolonged 1st or 2nd phase of labour
Use of oxytocin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Signs of shoulder dystocia in birth

A

Difficulty delivery face and chin, failure of restitution of head, failure of shoulders to descend, retracting head = turtle neck sign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of shoulder dystocia

A 
Call for help!
McRobert's Manoeuvre (thighs to abdo)
Suprapubic pressure
Consider episiotomy or internal manouevers e.g. rotation.
Discourage maternal pushing.
24
Q

Complications of shoulder dystocia

A 
Maternal = PPH, perineal tears, bladder injury.
Baby = brachial plexus injury (Erb's palsy), hypoxia, clavicle or humerus fracture.
25
Q

Types of uterine rupture

A

Incomplete/occult = at previous surgical scar, visceral peritoneum is intact, asymptomatic.
Complete = EMERGENCY!
Traumatic - RTA, oxytocin infusion, poorly conducted vaginal delivery.
Spontaneous - patients with Hx of c-section, multiparity.

26
Q

Clinical features of uterine rupture

A 
Abdo pain in 3rd trimester!
May refer to shoulder. Constant between contractions.
Vaginal bleeding.
Maternal shock!
Sudden shortness of breath.
Scar tenderness.
CTG abnormalities.
Haematuria
27
Q

Investigations and management of uterine rupture

A

TransVag USS.
ABCDE - resuscitate mum.
URGENT C-SECTION, contraindicate future vaginal births.

28
Q

Diagnosis of prolonged 3rd stage of labour

A

Not completed within 30mins if active management or within 1hr if no management.

29
Q

Main causes of retained placenta

A

Uterine atony, trapped placenta (closed os), placenta accreta or percreta

30
Q

Management of retained placenta

A

Analgesia for mum
IV oxytocin
Vaginal examination and manual removal - PAINFUL

31
Q

Complications of retained placenta

A

PPH
Genital tract infection
Uterine inversion - emergency!

32
Q

Definition of preterm labour

A

between 24 and 37weeks gestation labour.

33
Q

Prophylaxis for preterm

A

Vaginal progesterone or cervical cerclage - women with history of preterm babies or USS scan reveals cervical length shortening.

34
Q

Diagnosing preterm labour with intact membranes

A

Transvaginal USS - cervical length is less than 15mm.

or Fetal Fibronectin test -conc more than 50ng/ml

35
Q

Diagnosing preterm premature rupture of membranes

A

P-PROM

Speculum exam - pooling of amniotic fluid

36
Q

Managing P-PROM

A

Prophylactic Abx - erythromycin.
If over 34weeks gestation baby can be cared for in specialist unit.
If under 34weeks gestations consider:
Tocolysis (prevent labour) with nifedipine
Consider corticosteroids for mum (help with fetal pulmonary immaturity)
IV magnesium sulphate

37
Q

Risks with c-sections

A 
bladder injury
uterus injury
hysterectomy
VTE
future placenta praaevia
Uterine rupture
Neonatal respiratory morbidity.
38
Q

Analgesia steps

A 
1 = simple paracetamol, ibuprofen.
2 = opioids (single shot IM, morphine)
3 = PCA opioids IV (fentanyl)
4 = regional (epidural/spinal)
Also gas + air = Entonox
39
Q

Indications for an epidural

A

Multiple pregnancy,

instrumental delivery likely, maternal request, augmented labour.

40
Q

Contra-indications for an epidural

A 
Maternal refusal
Local infection
Septicaemia
Abnormal anatomy
Coagulopathy.
41
Q

Level of an epidural and spinal

A

L3/4, Tuffiers line

42
Q

Difference between epidural and spinal

A

Epidural goes between spinal dura and vertebral canal.

Spinal goes into subarachnoid space (mostly used for c-section)

43
Q

Diagnosis of delay in 2nd stage of labour active phase

A 
Nulliparous = longer than 2hrs
Multiparous = longer than 1hr
44
Q

meaning of early decelerations

A

deceleration of fetal heart rate on onset of contraction. mostly due to head compressions - non-reassuring

45
Q

late decelerations

A

utero-placenta insufficiency. ABNORMAL - fetal distress

46
Q

Variable decelerations

A

cord compression, independent of contractions.

47
Q

Action Line

A

On partogram, indicates need for intervention when measurements are worrying.

48
Q

Measurements on a partogram

A

FHR, Descent of head, cervical dilation, liquor, contractions, oxytocin infusion, drugs or fluids given, maternal HR, BP and temp, urine output, ketones and protein

49
Q

Meconium liquor causes

A

Fetal distress
Fetal maturity
Breech/malpresentation

50
Q

Another name for brow presentation

A

Mento-vertical

51
Q

Another name for face presentation

A

Submento-bragmatic

52
Q

Maternal fever, maternal tachycardia, and fetal tachycardia

A

Chorioamnionitis

53
Q

Drugs which encourage uterine quinescence (stop contractions if premature labour)

A

Nifedipine
Salbutamol
(tocolytic drugs)

54
Q

Serum marker indicating early labour

A

fetal fibrinonectin

55
Q

Antidote for oxytocin

A

Atosiban

56
Q

Side effects of epidural analegsia

A 
Hypotension
Haematoma at injection site
Anaphylaxis to medication
Post-dural headache
Spinal cord damage

Obs & Gynae (17 decks)

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