Maternity / obstetrics Flashcards
- The first stage of labour can be separated into early and active labour; what happens in early labour?
- What do contractions in early labour look like?
- How long does early labour last?
- How much does the cervix dilate in early labour?
- Cervix softens, thins and shortens in early labour.
- Contractions are infrequent, irregular in duration and less intense than in active labour (i.e. patient able to talk).
- Early labour typically lasts hours to days.
- Cervis typically dilates up to 6cm in early labour.
- The first stage of labour can be separated into early and active labour; what happens in active labour?
- What do contractions in active labour look like?
- How long does active labour last?
- How much does the cervix dilate in active labour?
- Cervix dilates in active labour - approx 1cm per hour
- Contractions are increasingly frequent, regular and stronger
- Active labour typically lasts 4-8 hours or more.
- Cervis typically dilates from approx. 4-10 cm in active labour
- The last part of active labour is the transition period; what happens in the transition?
- What do contractions in active labour look like?
- How long does active labour last?
- Cervix dilates from approx 7-10cm
- Contractions are frequent, regular and intense (i.e. patient typically unable to talk), typically lasting 60-90sec and occuring every few minutes. May also feel leg cramps, pressure in the back, nausea, and urge to push.
- Transition labour typically lasts 15min-1hr
What are the signs of imminent delivery?
- Appearance of presenting part at the vulva
- Spreading of the labia during contractions
- Involuntary pushing
- grunting
- vomiting
- “I can’t do this” and/or “don’t touch me”
During the second stage of labour, when should mum push? When should she stop pushing?
Push during contractions until head reaches the point of no return. Then pant / “breathe the baby out”.
What questions should be added to the patient assessment in pregnancy/birth?
- Number of previous pregnancies (gravida)
- Number of live births (parity)
- Number of miscarriages (M)
- Weeks gestation
- Number of babies
- Any complications in this/previous pregnancies
- Have you felt the baby move?
- Have your waters broken? What colour were they?
- Ante-natal care? Baby position?
What are the colour variations of the amniotic fluid? What do each of these colours mean?
- Clear / tinted yellow- normal
- Green - merconium in fluid indicates baby distressed / breech presentation
- Greenish yellow - post term pregnancy
- Tobacco colour - intrauterine death of foetus
- Dark coloured or blood stained - concealed haemorrhage in abruptio placenta
What are the signs of shoulder dystocia?
What maneouvres can be performed?
- Turtle-heading
- Failure to deliver head within next contraction
External maneouveres - McRoberts (knees to nipples) + supra-pubic pressure behind anterior shoulder
Internal (consult with on-call neonatologist via ECP) - deliver posterior arm, or woods screw to move posterior arm to be anterior
What are the risk factors for shoulder dystocia?
- Previous shoulder dystocia
- Macrosomia (large foetus) > 4kg
- Maternal diabetes mellitus
- Maternal obestity (BMI>30)
- Older maternal age (>35yrs)
- Post-term pregnancy
- Excessive weight gain during pregnancy
Within what time-frame should the newborn take its first breath?
Newborns should establish spontaneous effective respirations within 30 seconds; otherwise intervention is required
What are the components of MRSOPA?
Mask adjustment - size and fit
Reposition head - neutral or slightly extended
Suction mouth then nose - only if airway compromised
Open mouth - lift jaw forward
Pressure increased if no chest rise - lock BVM blow off valve, max 3 breaths, release lock
Artificial airway - SGA (e.g. size 1 i-gel) early if ventilations are still ineffective
In newborn resus, how many rounds of ventillation are given before CPR is considered?
2 rounds
* 1st round - cut cord if needed, ensure baby warm, head properly positioned
* 2nd round - MRSOPA
Ventillations provided with Room Air for first two rounds
If the newborn has HR< 60 after two rounds of ventillation, what should be done?
Commence CPR 3:1
100% O2 (10L/min)
Pause for ventillations
If the newborn has HR 60-< 100 after two rounds of ventillation, what should be done?
IPPV 40 – 60 per min
100% oxygen (10 L/min)
SpO2 monitoring (pre ductal - right hand)
If the newborn has HR >100 after two rounds of ventillation but theres’ still
* ineffective breathing
* no cry
* poor muscle tone, or
* persistent cyanosis
what should be done?
oxygen therapy (10 L via tubing in vicinity of nose and mouth)
SpO2 monitoring (pre ductal - right hand)
