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BS - Reproductive System > Normal & Abnormal Labour/Antenatal Care > Flashcards

Normal & Abnormal Labour/Antenatal Care Flashcards

1
Q

What happens during the first stage of labour?

What is the progression?

A

Cervix dilation from 4cm to 10cm

Progression of 0.5 cm per hour

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2
Q

What happens during the second stage of labour?

How long does it last?

A

This is from full dilation of cervix (10cm) until delivery of the baby

Should last 2-3 hours

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3
Q

What happens during the third stage of labour?

How long does it last?

A

From delivery of the baby until delivery of the placenta

Should last up to 1 hour

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4
Q

What are the 8 cardinal movements of labour as they happen during birth?

A
  1. head floating before engagement
  2. engagement - descent, flexion
  3. further descent, internal rotation
  4. complete rotation, beginning extension
  5. complete extension
  6. restitution (external rotation)
  7. delivery of anterior shoulder
  8. delivery of posterior shoulder
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5
Q

What are the 7 cardinal movements of labour in order?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation (restitution)
  7. Expulsion

Every Day Fine Infants Enter Eager and Excited

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6
Q

What is meant by the cardinal movements of labour?

A

changes in the position of the foetus’s head during its passage in labor

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7
Q

What are the 3 P’s that describe the causes of abnormal pregnancy?

A
  1. passenger
  2. power
  3. passage
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8
Q

What can go wrong with each of the 3 P’s?

A
  1. passenger - the size, position or distress
  2. power - inadequate contractions
  3. passage - pelvic dimensions
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9
Q

What are the 3 types of forceps used in assisted pregnancy?

A
  1. neville-barns
  2. keillands
  3. ventouse
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10
Q

What is a breech delivery?

A

When the baby’s bum or legs present first

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11
Q

What is the difference between a cephalic and transverse presentation?

A

Cephalic presentation is the ideal position for birth - the baby’s head is presenting

Transverse presentation is when the baby is lying with its head to either side

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12
Q

What is the definition of pain?

A

An unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage

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13
Q

What is the definition of pain relating to the woman in labour?

A

Whatever the experiencing person says it is, existing whenever she says it does

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14
Q

What are the 2 main non-pharmacological pain reliefs?

A
  1. water birth

2. transcutaneous electrical nerve stimulation (TENS)

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15
Q

What are the pharmacological ways of giving pain relief?

A
  1. oral
  2. inhalation
  3. injection
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16
Q

What are the regional ways of giving pain relief?

A
  1. epidural
  2. spinal
  3. combined epispinal
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17
Q

What are the stages in the analgesic ladder?

A
  1. non-opioid such as paracetamol, aspirin or NSAID
  2. add an opioid for mild-moderate pain such as codeine or tramadol
  3. add opioid for moderate to severe pain - morphine, fentanyl
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18
Q

What pain relief methods are used in early pregnancy?

A
  1. simple analgesia - paracetamol and codeine
  2. TENS
  3. water and heat
  4. meditation and relaxation techniques
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19
Q

What non-pharmacological analgesia methods are used during late pregnancy and early labour?

A
  1. TENS
  2. warm water - bath or water birth
  3. support from birth partner or midwife
  4. reassurance
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20
Q

What are the first line pharmacological methods used in late pregnancy and early labour?

A
  1. paracetamol

2. weak opioids - codeine

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21
Q

What analgesic medication must NOT be used in pregnancy?

Why?

A

Ibuprofen

It causes premature closure of the ductus arteriosus

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22
Q

What inhalation agents are used as analgesia in advancing labour?

A
  1. nitrous oxide

This is known as ‘entonox’ or ‘gas and air’

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23
Q

What are the side effects of nitrous oxide?

A

dizziness, nausea and amnesia

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24
Q

What pharmacological analgesia is used in advancing labour?

A
  1. opioids

This is mainly diamorphine

Pethidine used to be used (except in epilepsy)

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25
Q

What are the side effects of diamorphine?

A
  1. sedation
  2. nausea and vomiting
  3. respiratory depression
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26
Q

What pain relief is used in advanced labour?

A
  1. lumbar epidural
  2. spinal
  3. combined spinal and epidural
27
Q

What are the local techniques used in advanced labour?

A
  1. perineal infiltration

2. pudendal block - local anaesthetic

28
Q

What is the difference in the positions that epidural and spinal anaesthesia is injected?

A

Epidural goes in the epidural space

(posterior to dura matter)

Spinal goes in the subarachinoid space containing CSF

(anterior to dura matter)

29
Q

When is general anaesthetic used in pregnancy?

A

Only in emergency situations

This is usually an emergency Caesarean section where mother/baby is in serious danger

30
Q

Why is general anaesthetic only used in emergency situations?

A

It involves the mother being unconscious at birth

This means the baby may be affected

31
Q

What is antenatal care?

A

The care that women receive from healthcare professionals during pregnancy

32
Q

What is the purpose of antenatal care?

A

To ensure the health and wellbeing of both mum and baby

It provides useful information to help women have a healthy pregnancy

33
Q

What is involved in antenatal care?

A

A series of appointments with a midwife, or sometimes an obstetrician

Routine ultrasound scans

34
Q

What are the 3 principles of good antenatal care?

A
  1. information is given in a form that is easy to understand and is accessible
  2. it is based on current available evidence
  3. women’s decisions should be respected, even when this is contrary to the views of the healthcare professional
35
Q

Upon presenting to the GP with a pregnancy, what advice should be given?

A
  1. take folic acid and vitamin D supplements
  2. nutrition, diet and food hygiene advice
  3. stop smoking, drinking and taking recreational drugs
36
Q

When is the first dating scan performed?

A

Within 8-14 weeks of pregnancy

37
Q

What is the purpose of the dating scan?

A
  1. giving an estimated due date

2. screening for possible abnormalities undertaken along with specific blood tests

38
Q

What is the anatomy scan and when does it take place?

A

It checks the physical development of the baby and looks for any physical abnormalities

Occurs at 18-20/26 weeks

39
Q

How many antenatal appointments are offered to pregnant women?

A

First time parents are offered up to 10 appointments

If it is not the first child, it is around 7

Under certain conditions, such as medical conditions, there may be more

40
Q

When do antenatal appointments become more frequent?

A

From around 24 weeks of pregnancy

41
Q

What is performed during later antenatal visits?

A
  1. check urine and blood pressure
  2. palpate to check baby’s position
  3. check the baby’s growth
  4. listen to the baby’s heartbeat
42
Q

How is the baby’s growth checked?

A

By measuring the distance from the top of the womb to the pubic bone

(symphasis-fundal height)

43
Q

What is involved in the post-natal check?

When does this occur?

A

Occurs 6 weeks after delivery with a GP to ensure women are recovering

It is a good time to discuss contraception

44
Q

What are the risk factors that must be determined in a high-risk antenatal visit?

A
  1. complications in a previous pregnancy/delivery - e.g. pre-eclampsia or premature delivery
  2. current treatment for a chronic disease such as diabetes or hypertension
  3. previous baby with an abnormality in the family- e.g. spina bifida
  4. family history of inherited disease
45
Q

If a pregnancy is deemed ‘high-risk’, how does antenatal care differ to normal?

A
  1. more hospital appointments and USS
  2. consultant-obstetrician led care
  3. hospital as place of birth
  4. may be delivered before 40 weeks by induction or C-section
46
Q

Why is it important to find out about pre-existing maternal disease?

A

Pre-existing maternal disease can have an adverse effect on pregnancy

Pregnancy can have an adverse effect on pre-exisiting maternal disease

47
Q

Which region has the highest rate of maternal mortality?

A

Sub-Saharan africa

48
Q

What is a stillbirth?

A

A baby that is born dead after 24 completed weeks of pregnancy

49
Q

What is the difference between a stillbirth and a miscarriage?

A

If the baby dies before 24 completed weeks, this is a miscarriage

50
Q

How many stillbirths are there in the UK?

A

> 3,600 stillbirths every year in UK

1 in every 200 babies

51
Q

What is the extra USS provided to high risk pregnancies?

A

Growth USS

This checks to see if the baby is growing appropriately and occurs at 28 and 34 weeks

52
Q

What is the definition of ‘screening’?

A

A process of identifying apparently healthy individuals who may be at increased risk of a disease or condition

53
Q

Why do ethics play a large role in screening?

A

Ethics has an important role in evaluating potential benefit vs. harm and whether to offer the test

54
Q

In the antenatal period, what conditions are regularly offered to be screened for?

A
  1. infectious diseases - HIV, Hep B, syphilis and rubella
  2. rhesus negative
  3. haemoglobinopathies
  4. foetal abnormalities
55
Q

What haemoglobinopathies are screened for?

A

This identifies carriers of sickle cell disease and thalassaemia

56
Q

When does rhesus disease occur?

A

When the mother has rhesus negative blood and the baby has rhesus positive blood

57
Q

What happens during delivery when a RhD- mother gives birth to a RhD+ foetus?

A

Antigens from the foetus enter the mother’s blood

The mother produces anti-Rh antibodies

58
Q

What happens if a woman carrying anti-Rh antibodies becomes pregnant with another RhD+ foetus?

A

The anti-Rh antibodies will cross the placenta

This causes damage to foetal red blood cells

59
Q

What treatment is offered to RhD- women?

A

Anti-D at 28-30 weeks

Another Anti-D is given after delivery is the baby is Rh+

60
Q

How does the Anti-D treatment work?

A

It neutralises foetal RhD+ antigens

This prevents creation of antibodies by the mother

61
Q

What are the 2 screening tests for foetal anomalies?

A
  1. down’s syndrome screening

2. anomaly scan

62
Q

When is Down’s syndrome screening performed?

A

It is an opt-in test

If chosen, it is performed in the first trimester at the dating scan

63
Q

What is involved in the Down’s syndrome “combined screening”?

A
  1. nuchal translucency scan
  2. blood test for:

human chorionic gonadotrophin (hCG)

pregnancy-associated plasma protein A (PAPP-A)

BS - Reproductive System (12 decks)

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