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CP2 OBGYN > Mx of Labour and Delivery > Flashcards

Mx of Labour and Delivery Flashcards

1
Q

Signs that labour is on the way (4)?

A

Braxton Hicks contractions become > freq
Pressing part becomes
Uterine fundus descends
P in pelvis increases

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2
Q

Diagnosis of labour

A

Painful uterine contractions + dilation + effacement of cervix

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3
Q

Stage 1 labour

A

Cervix opens –> full dilation (10cm)

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4
Q

Stage 2 labour

A

Cervical dilation –> delivery

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5
Q

Stage 3 labour

A

Delivery foetus –> delivery placenta

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6
Q

What are the 3 factors determining the progression of labour?

A

Powers
Passage
Passenger

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7
Q

What is ‘Power’

A

Degree of force expelling foetus

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8
Q

What is ‘Passage’

A

Dimension of pelvic + resistance of soft tissue

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9
Q

What is ‘Passenger’

A

Diameter of foetal head

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10
Q

What is effacement

A

The cervix being pulled up

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11
Q

Dimensions of pelvic inlet

A

TD - 13cm > AP - 11cm

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12
Q

Dimensions of pelvic mid-cavity

A

TD = AP

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13
Q

Dimensions of pelvic outlet

A

AP - 12.5 > TD 11cm

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14
Q

How is the level of descent measured?

A

From Ischial spines

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15
Q

What 3 things does cervical dilation depend on?

A

Contractions
P of foetal head
Ability to soften

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16
Q

Name of anterior fontanelle

A

Bregma

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17
Q

Name of posterior fontanelle

A

Occiput

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18
Q

what is between the bregma and occiput?

A

Vertex

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19
Q

What is attitude

A

Degree of flexion of head/neck

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20
Q

What is the ideal attitude?

A 
Vertex presentation (maximal flexion) 
Presenting diameter - 9.5cm
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21
Q

What has a diameter of 13cm

A

Extension 90’

Brow presentation

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22
Q

What has a diameter too large to deliver?

A

Face presentation

exxtension 120’

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23
Q

What is position

A

Degree of rotation of head on neck

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24
Q

What is moulding

A

Head is able to be squashed with bones overlapping hence decr diameter

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25
Q

What occurs in the initiation of labour

A

Involuntary contraction of uterine SM

Incr PG –> Decr cervical resistance + oxytocin released

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26
Q

Latent phase stage 1 labour

A

Cervix dilates slowly for first 4cm. This can take several hrs

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27
Q

Active phase stage 1 labour

A

Rate of 1cm/hr nulliparous

Rate 2cm/hr multiparous

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28
Q

What is the longest stage 1 of labour should take?

A

16hrs

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29
Q

4 stages of stage 2 of labour

A

Descent –> flexion –> rotation –> extension

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30
Q

Passage stage 2 labour

A

Full dilation - head reaches pelvic floor

Lasts mins

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31
Q

Active stage 2 labour

A

Mother is pushing

Pressure of head on pelvic flr forces women to bear down

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32
Q

How long does active stage 2 take nulliparous woman

A

40 mins

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33
Q

How long does active stage 2 take multiparous women

A

20 mins

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34
Q

After reaching the perineum, how does the head come out of the pelvis

A

It extends

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35
Q

After the head extends, what comes next

A

Head rotates back to transverse position + descend w/ next contraction

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36
Q

How long does stage 3 labour normally take?

A

15 mins

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37
Q

What is the normal blood loss in the 3rd stage of labour?

A

500ml

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38
Q

Obs - what should be checked every 15 mins

A

Foetal HR

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39
Q

Obs - what should be checked every 30 mins

A

Uterine contractions

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40
Q

Obs - what should be checked every 1hr

A

Maternal HR

41
Q

Obs - what should be checked every 4hours

A

VE
Maternal BP + temp
Urine dip - protein + ketones

42
Q

Which positions are good for delivery? (3)

A

Squatting
Kneeling
L lateral position

43
Q

Why should women in labour not lie in the supine position?

A

Aortocaval compression –> Incr CO + Decr BP

44
Q

Mx pyrexia in labour

A

Take cultures from - vagina, urine, blood

Give - paracetamol, IV ABx, CTG

45
Q

How anxiety and fear affect labour

A

Adrenaline secreted

Inhibition of uternie contraction

46
Q

What is the most common cause of slow progress through labour?

A

Inefficient uterine action

47
Q

Who is more likely to have inefficient uterine action

A

Nulliparous women

IOL/Epidural

48
Q

Mx Inefficient uterine action

A

Continuous support - reduce anxiety
Encourage mobility
Augmentation of labour –> amniotomy + oxytocin
CSC if not by 12-16hrs

49
Q

Affect of hyperactive uterine action (3)

A

Decr placental blood flw
Rapid labour
Placental abruption

50
Q

Tx hyperactive uterine action

A

If no abruption - tocolysis

CSC if foetal distress

51
Q

Augmentation

A

Artificial strengthening of contractions in established labour

52
Q

Induction

A

Artificial initiation of labour

53
Q

Effect of OP persentation on labour

A

Incr time + Pain

Backache + early desire to push

54
Q

Mx of OT presentation

A

Rotate with traction using ventouse

55
Q

What is Brow presentation?

A

Extension of foetal head –> large presenting diameter –> won’t deliver vaginally

56
Q

What can you feel on VE in Brow presentation?

A

Anterior fontanelle supraoribital ridges + noses palpable

57
Q

Mx Brow presentation

A

CSC

58
Q

What is face presentation?

A

Complete extension of foetal head hence face presents

59
Q

What can you feel on VE in face presentation?

A

Mouth, nose + eyes palpable

60
Q

Mx face presentation

A

Can deliver vaginally

61
Q

When would you need a CSC for face presentation?

A

If chin = posterior

62
Q

Who is cephalo-pelvic disproportion more common for? (2)

A

Large baby

Short woman

63
Q

Severe causes of damage to foetus during labour (5)

A 
Hypoxia 
Infection/inflammation in labour
Meconium aspiration 
Trauma 
Foetal blood loss
64
Q

RF/causes of foetal damage during labour (8)

A 
Long labour 
>1hr pushing time 
Abruption 
Hypertonic uterine state 
Use of oxytocin/epidural 
Cord prolapse
Maternal hypotension 
Pre-eclampsia
65
Q

ways of Diagnosis of foetal distress in labour (4)

A

Colour of meconium
FHR
CTG
FBS

66
Q

How often is FHR ausculatated in 1st stage labour

A

Every 15mins

67
Q

How often is FHR ausculatated in 2nd stage labour

A

Every 5 mins

68
Q

How is a FBS taken?

A

Amnioscope inserted vaginally –> cervix –> babies scalp –> collect blood

69
Q

Mx of foetal distress in labour

A 
In utero resus = 
L-lateral position 
O2 + IV fl 
Stop oxytocin
Can stop contractions w/ B2 agonist e.g. terbutaline 
VE - exclude prolapse
70
Q

What is the rate of O2 consumption of a foetus compared to an adult?

A

2x

71
Q

How long can a foetus be supported by its O2 reserves?

A

1-2mins

72
Q

What are the 5 main groups of reasons a fetus’s O2 can be impaired?

A 
Placental conditions 
Maternal conditions 
Fetal condition 
Uterine condition 
Umbilical cord condition
73
Q

3 examples of placental conditions affecting foetal O2 supply

A

Infarction
Abruption
Post-mature placenta

74
Q

6 examples of maternal conditions affecting foetal O2 supply

A 
HTN
HoTN
Severe anaemia 
Cardiac disease
Seizures
Pulmonary disease
75
Q

3 exams of foetal conditions that affect foetal O2 supply

A

Anaemia
Infection
Twin-twin transfusion

76
Q

2 examples of uterine conditions affecting foetal O2 supply

A

Tetanic contraction

Hyperstimulation

77
Q

5 examples of umbilical cord condition that affect foetal O2 supply

A 
One aa
Haematoma 
Short cord 
True knot 
Nuchal cord prolapse
78
Q

Which develops first, the SNS or paraSNS

A

SNS

79
Q

Indications CTG (17)

A 
IOL
>42weeks 
Previous LSCS
Maternal cardiac problems 
Pre-eclampsia or HTN
Prolonged rupture membranes >24hrs 
<37weeks 
Small for gestation age 
Oligohydramnios 
Abnormal umbilical aa Doppler 
Multiple pregnancy 
Meconium stained liquor 
Abnorm lie - Breech 
Oxytocin augmentation 
Epidural anaesthesia 
Pyrexia 
Abnormality heard on ausc
80
Q

What is the false +ve rate of CTG for fetal hypoxia?

A

50%

81
Q

DR C BRAVADO

A 
DR - determine risk 
C - contractions 
BRA - baseline HR
V - variability 
A - accelerations 
D - decelerations
82
Q

What should the Baseline heart rate of a fetus be?

A

100-160

83
Q

Causes of sustained tachyC (4)

A

Prematurity
Fetal hypxia
Maternal pyrexia
Use of exogenous B-sympathomimetics

84
Q

Causes of baseline bradycardiac (3)

A

Fetal acidosis
HoTN
Maternal sedation

85
Q

What should variability be between?

A

5-25

86
Q

What is variability

A

The interplay between CNX (PNS) and SNS

87
Q

Causes of reduced variability (6)

A 
Baby sleeping (40mins)
Fetal hypoxia 
Malformation 
Mg 
Prematurity < 2w 
Dx - pethidine, morphine
88
Q

What is an acceleration

A

Upward spike of >15bpm for >15s

89
Q

What does an acceleration mean

A

Baby is moving

90
Q

What is a deceleration

A

Downward spike of >15bpm for >15s

91
Q

What are early decelerations

A

Baroceptor decelerations

Mimic shape + timing of contraction by foetal head compression

92
Q

What are late decelerations

A

Chemoreceptor decelerations

Signs of acidosis

93
Q

What is an atypical deceleration

A

Loss of shouldering, last >60s, >60bpm, may be slow to recover by a W shape + lose variability with the decelerations

94
Q

What may atypical decelerations be a sign of?

A

Fetal hypoxia

95
Q

3 classifications of CTG

A

Reassuring
Non-reassuring
Abnormal

96
Q

How to improve a CTG (3)

A

L Lateral position
IV fl
Reduce/stop oxytocin if contraction >5:10 or bradyC

97
Q

WHy is hyperstimulation bad (2)

A

Increases resting tone of uterus

O2 in retroplacental blood pool isn’t properly replenished betw contractions

98
Q

Mx hyperstimulation

A

Terbutaline 250mg

CP2 OBGYN (21 decks)

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