Module 10 : Labour and Delivery Flashcards
what is labour defined as
- uterine fundal contractions
- progressive effacement and dilation of cervix
- loss of mucous plug
- a blood show
- rupture of membranes
what are the characteristics of the first stage of labour
- progressive cervical effacement and dilatation
- descent of fetus into the maternal pelvis
- regular contractions
- duration varies 12-24 hours
- normal progression of cervical dilation is about 1cm/hour
what are the characteristics of the second stage of labour
- cervix is fully dilated to birth of baby (pushing)
- variable times
+ average 50 minutes primigravida
+ 20 minutes multiparous
what are the characteristics of the third stage of labour
- birth to expulsion of placenta
- 10 minutes
- oxytocin released
what is the usually presentation of fetus for labour
- vertex
- 4 % breech
what is dystocia
- difficult birth
what is another name for dystocia
- dysfunctional labour
- failure to progress = cervix not changing with contractions
what are 3 causes of dystocia
- disproportion between the fetal head and the maternal pelvis (head to big for maternal pelvis)
- mass obstructing way
- abnormal presentation or position
what are 3 associations with heavy bleeding
- placenta previa
- abruption
- PROM
what are the 8 reasons for induction of labour
- mild abruption
- IUGR
- post dates
- amnionitis
- PROM
- maternal disease
- fetal death
- history of quick delivery but far from hospital
what is meconium
- black tarry substance in the neonates firs tbowel movement
- should have first bowel movement after birth but can occur in utero if fetus is in distress
what is fetus at high risk for is aspiration of meconium occurs
- lung infection
when is a c section performed
- footling or incomplete breech
- prolonged membrane rupture and no uterine contractions or labour has occured
- fetal distress
- dysfunctional labor
- > 4kg weight
- small maternal pelvis
- social
what are 3 diagnostic tests done in about and delivery
- lecithin/sphingomyelin ratio (2:1 fetal lungs mature)
- non stress test
- fetal scalp blood gases
what is the post partum period
- from placental expulsion to restoration of uterus to pre pregnant state
- takes about 6-8weeks
what is the purpose fo post partum ultrasound
- post partum hemorrhage
- ?RPOC
- infection
- c section incision infection
what is the characteristics of normal post partum uterus
- length 15-25cm
- up to maternal umbilicus
- prominent vessels
normal endometrium post partum
5-13mm
norma postpartum adnexa
- broad ligaments identified
- ovaries identified (large if breast feeding)
what are 3 post partum abnormalities
- hemorrhage
- infection
- RPOC
what are the causes of post partum hemorrhage
- acute (atony) = lack of muscle tone
- bleeding controlled by uterine contraction if uterus cannot contract bleeding occurs
what is lochia
- vaginal discharge of mucous, blood and tissue
- normal post partum occurrence
what is associated with uterine atony
- multi fetal pregnancy
- macrosomia
- prolonged labour
- more than 5 full term births
- rapid labour
- poly
- chorioamnionitis
what increases post partum hemorrhage risks
- prior c section
- prior placental abnormality
- maternal ae >35
- prior myomectomy
- endometrial defects - decider basalis
- anterior placental previa with priori c section
- PLACENTA ACRETA
when does a placenta accreta occur
- damage to the endometrium-myometrial interface
+ uterine scar
+ can occur in primigravida women with no surgical history but have uterine pathology
what are three tricks to use to determine placental acreeta
- clear zone between placenta and myometrium does it compress(bounce)
- numerous placental lacunau
- placental bulge thin myometrium
what is a strong sonographic indicator for RPOC
- echogenic heterogeneous mass = blood clots or infected material
what is the clinical history for maternal infection post partum
- increase temp
- pain
- endometritis
- after rupture of membranes vagina becomes alkaline encouraging bacterial growth
- treated with anti biotic
what is the sonographic appearance of infection
- overlapping appearance of endometritis and retained products
- dilated uterine cavity with fluid
- normal endo/uterus
- gas in endo
- BOTH FLUID AND GAS IN END
what is. common complication from C section
- infection at incision site
what is the normal appearance of C section scar
- small rounded anechoic area in anterior uterine wall
- look between the anterior wall fo the bladder and lower uterine segment
where is a common location of hematoma and what do they look like
- potential space between the bladder and uterus
- complex or anechoic mass >2cm adjacent to scar
characteristics of abscess
- wound infection
- similar appearance to hematoma, may see gas bubbles
- patient febrile
- increased WBC
what is female genital mutilation FGM
- partial or total removal of the external genitalia or injury to the femal genital organs
what is type I FGM
- removal of clitoral glans
what is type II FGM
- removal of clitoral glans and labia minor
what is type III FGM
- narrowing of the vaginal opening with the creation of a covering seal by cutting and apportioning the labia minora or labia majora
what is type IV FGM
- all other harmful procedure to the female genitalia for non-medical purposes
what are the complications of FGM
- infection
- urinary retention
- menstrual retention
ultrasound role in FGM
- with type III FGM EV scan contraindicated
