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Reproduction > Lecture 11 Normal Labour Abnormal Labour and Postnatal Period > Flashcards

Lecture 11 Normal Labour Abnormal Labour and Postnatal Period Flashcards

1
Q

What period of gestation does normal labour occur

A

37-42 weeks gestation

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2
Q

Name the 4 key changes at the beginning of labour

A

Cervix softens
Myometrial tone changes
Progesterone decreases
Oxytocin and Prostaglandin increase to initiate labour

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3
Q

Name the 3 phases of the first stage of labour

A

Latent- dilatation up to 4cm
Active- 4-10cm
Transition- 8-10cm

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4
Q

What happens during the second stage of labour

A

Passive and Active stage

Ful dilatation to birth

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5
Q

What happens during the third stage of labour

A

Birth of baby

Expulsion of the placenta

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6
Q

Name the 3 foetal lies

A

Cephalic
Breech
Transverse lie

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7
Q

Name the 5 Foetal presentation

A 
Face
Brow
Vertex
Breech
Shoulder
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8
Q

Name the 3 Feotal Positions

A

Occipitoposterior
Occipitotransverse
Occipitoanterior

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9
Q

What is a normal foetal heart rate?

A

110-160bpm

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10
Q

Name drug free labour analgesia

A

Birthing ball
Birthing pool
Hypnobirthing
Aromatherapy

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11
Q

Name simple drug therapies for labour analgesia

A

Entonox (Gas and Air)

Diamorphine

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12
Q

Name the benefits of Entonox

A

Takes 30 seconds to work
Safe
Mother in control
Can be used with other pain relief techniques

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13
Q

Name disadvantages of Entonox

A

Wears off quickly
Dizzy, dry mouth, sick
Won’t take pain away

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14
Q

Name benefits of diamorphine

A

Injection at top of the leg
Last 4 hours
Strong pain relief and relaxation

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15
Q

Name disadvantages of diamorphine

A

Makes you feel sick, sleep and slow down breathing. Has same effect on baby

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16
Q

Name advanced drug techniques for labour analgesia

A

Remifentanil PCA

Epidural

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17
Q

What are the benefits of Remifentanil PCA

A

Morphine like pain relief
Mother in control
Small amount given as a pump when button is pressed
Works quickly

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18
Q

What are the disadvantages of Remifentanil PCA

A 
Wears off quickly
Can slow down breathing
Can make you feel drowsy
Cannot start this drug if you've have diamorphine after 4 hours
Drowsy, sick and itchy
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19
Q

What are the benefits of epidural

A 
Can self-administer
20 minutes to work
Can still use gas and air
Does not affect baby
You are in control
Can be topped up with stronger medicine
Does not slow down cervix dilatation
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20
Q

What are the disadvantages of an epidural

A 
Can slow pushing phase
Risk of forceps/suction cups
Drop in blood pressure
Itching, fever
Sore back
Headache
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21
Q

Name the complications of an epidural

A 
Nerve damage
Epidural abscess
Meningitis
Haematoma
Unconsciousness
Severe injury
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22
Q

Name potential indications for the induction

A 
Hypertensive disorders
Maternal diabetes
Prolonged pregnancy
Twin pregnancy
Prelabour rupture of membranes 
Foetal growth restriction or macrosomia
Previous stillbirth or in utero death
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23
Q

Name contraindications for induction of labour

A 
Malpresentation
Placenta praaevia 
Prolapsed umbilical cord
Foetal distress
Pelvic tumour
Previous C-section
Maternal asthma
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24
Q

What is a bishop score used to assess

A

Cervix position, consistency, dilatation

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25
Q

What does a low bishop score mean

A

Not ready for labour

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26
Q

What does a high bishop score mean

A

Ready for labour

27
Q

What medications can be done to induce labour

A

Topical prostaglandin analogues (misoprostol)

IV synthetic oxytocin

28
Q

What does Oxytocin causes

A

Initiates uterine contractions

29
Q

Describe the process of induction of labour

A

Once cervix has dilated and effaced an amniotomy is performed
IV oxytocin id administered(4-5 contractions in 10 minutes)

30
Q

What Bishop score is considered favourable for amniotomy

A

7+

31
Q

Name Intrapartum complications

A

Inadequate uterine activity
Cephalopelvic (powers)
disproportion, obstruction (passages)
Malposition (passenger)

32
Q

What are the main causes of foetal distress

A

Hypoxia, infection, cord prolapse, placental abruption and vasa praaevia

33
Q

Name 4 types of foetal monitoring

A

Intermittent auscultation of the foetal heart
CTG
Foetal blood sampling
Foetal ECG

34
Q

When is foetal blood sampling carried

A

Used when abnormal CTG

35
Q

What can you measure from foetal blood sampling

A

pH (hypoxaemia) and base excess, lactic acid

36
Q

Name third stage complications

A

Retained placenta
Pst-partum haemorrhage
Tears

37
Q

What are the 4 causes of Postpartum Haemorhage

A

Tone
Trauma
Tissue
Thrombin

38
Q

Describe a 3rd degree tear

A

Involving anal sphincter complex

39
Q

Describe a 4th degree tear

A

Involving rectal mucosa

40
Q

Name complications with breast feeding

A

Mastitis
Blocked milk ducts
Difficulty feeding/baby latching
Cracked nipples

41
Q

Name 5 key postnatal conditions

A 
Post-partum haemorrhage
Venous thromboembolism
Sepsis
Psychiatric disorders
Pre-eclampsia
42
Q

What is primary postpartum haemorrhage

A

Blood loss >500ml within 24 hours

Tone, trauma, retained tissue, thrombin

43
Q

What is secondary postpartum haemorrhage

A

Blood loss >50ml from 24 hours post party to 6 weeks

44
Q

What is the presentation of thromboembolic disease

A

Unilateral leg swelling
SOB or chest pain
Unexplained tachycardia

45
Q

How do you investigate thromboembolic disease

A

ECG
Leg dopplers
CXR +/- VQ scan

46
Q

How do you treat thromboembolic disease

A

Low molecular weight heparin

Warfarin is teratogenic (can be used when breast feeding)

47
Q

Not breastfeeding increases what risks for babies

A 
Gastroenteritis
Respiratory infections
Allergies
Obesity
Type I and II diabetes
SIDS
48
Q

Not breastfeeding increases what risks for mothers

A

Breast cancer
Ovarian cancer
Hip fractures
Heart disease

49
Q

What is the WHO/Unicef UK baby friendly initiative

A

Requires that all baby friendly accredited services adhere to the international code of marketing of breastmilk substitutes (the code)

50
Q

Name the 3 stages of lactation

A
  1. Breast development and colostrum production
  2. Onset of copious milk secretion
  3. Maintenance of milk production
51
Q

What happens to the oestrogen and progesterone levels after birth

A

They drop

52
Q

What is role of Prolactin

A

Responsible for milk production (lactocyte production)
Responsive to touch and stimulation
Levels higher at night

53
Q

What is the role of oxytocin

A

Responsible for milk delivery
Acts on muscle cells in pulsatile action
Levels higher when baby is near

54
Q

What is the importance of skin to skin contact

A

Triggers lactation and mothering hormones
Regulates tem, HR and breathing
Colonises baby with microbes from mother
Stimulates feeding behaviour
Reduces stress hormones in mother and baby

55
Q

What is Shoulder Dystocia

A

Occurs when the anterior foetal shoulder becomes impacted behind the maternal pubic symphysis after delivery of the foetal head

56
Q

What is the management of Shoulder Dystocia

A
  • H – Call for Help
  • E – Evaluate for Episiotomy
  • L – Legs (McRoberts Position)
  • P – Suprapubic Pressure
  • E – Enter Manouvers (Internal Rotation)
  • R – Remove the Posterior Arm
  • R – Roll the Patient (Onto all Fours)
57
Q

Name thrombin related causes of PPH

A

Pre-eclampsia
Placental abruption
Pyrexia in labour
Bleeding disorders

58
Q

Name tissue related causes PPH

A

Retained placenta
Placenta accreta
Retained POC

59
Q

Name tone related causes of PPH

A

Placenta praaevia
Over distention of uterus
Uterine relaxants
Previous PPH

60
Q

Name trauma related causes PPH

A

C-section
Epiostomy
Macrosomia

61
Q

Name other causes of PPH

A 
Asian ethnicity
Anaemia
Induction
BMI>35
Prolonged labour
Age
62
Q

What is the medical management of PPH

A 
ABCDE
Empty bladder
-	Oxytocin 5iu slow iv injection
-	Ergometrine 0.5mg slow iv injection (not if high BP)- cause heavy contractions
-	Oxytocin infusion
-	Tranexamic acid 1g IV	- controls bleeding
-	 Carboprost 0.25mg im (max 8 doses 
-	Misoprostol 800 micrograms)
63
Q

What is the surgical management of PPH

A 
Intrauterine balloon tamponade
Interventional radiology
B-lynch suture
Hysterectomy
Fluid replacement +/- blood products
64
Q

What is the management for a cord prolapse

A

Replace cord in vagina
Catheterise and fill bladder
Encourage mother to adopt knee chest or left lateral position with raised hip
Arrange for c-section

Reproduction (29 decks)

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