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Obs & Gynae (Obs) > Normal Delivery & Puerperium > Flashcards

Normal Delivery & Puerperium Flashcards

1
Q

The foetal head is described as being engaged when the widest part has passed what anatomical landmark?

A

Pelvic inlet

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2
Q

The descent of the foetus during labour can be assessed using what terminology?

A

Stations

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3
Q

As the foetal head descends in labour, what position is it usually in?

A

Occiput-transverse

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4
Q

Descent of the foetus in labour is most effective when the head is in what position?

A

Flexion

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5
Q

In labour, at the level of the pelvic outlet, the foetus makes what cardinal movement to end up in what position?

A

Internal rotation to be occiput-anterior

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6
Q

What term is used to describe the appearance of a large segment of the foetal head at the introitus?

A

Crowning

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7
Q

Which cardinal movement of the foetus occurs as it is crowning?

A

Extension

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8
Q

At restitution, after the foetal head has been delivered, what cardinal movement occurs?

A

External rotation

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9
Q

After the head, what is usually the next part of the foetus to deliver in labour?

A

Anterior shoulder

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10
Q

What are the three main factors influencing labour?

A

Power, passenger, passage

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11
Q

Up to how many uterine contractions in 10 minutes would be considered normal in labour?

A

3-4

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12
Q

What is the normal foetal lie at labour?

A

Longitudinal

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13
Q

What is the normal foetal presentation at labour?

A

Cephalic

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14
Q

What is the normal foetal position at labour?

A

Occiput-anterior

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15
Q

What part of the foetus should present first in labour?

A

Vertex

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16
Q

Which hormone is responsible for inhibiting uterine contractions throughout pregnancy?

A

Progesterone

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17
Q

Which hormone stimulates the production of uterotonic substances such as oxytocin and prostaglandinds which trigger uterine contractions?

A

Oestrogen

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18
Q

Describe the beginning and end points of the first stage of labour?

A

The onset of contractions until the cervix is fully dilated and effaced

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19
Q

The latent phase of the first stage of labour lasts until the cervix is dilated how far?

A

4cm

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20
Q

The active phase of the first stage of labour lasts until the cervix is dilated how far?

A

10cm

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21
Q

Describe the beginning and end points of the second stage of labour?

A

From the cervix being 10cm dilated to the delivery of the baby

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22
Q

Describe the beginning and end points of the third stage of labour?

A

From the delivery of the baby to the delivery of the placenta and membranes

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23
Q

Describe the contractions which occur in the latent phase of the first stage of labour?

A

Mild and irregular

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24
Q

Describe Braxton-Hicks contractions?

A

Relatively painless contractions which do not increase in intensity or frequency

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25
Q

Describe the contractions which occur in the active phase of the first stage of labour?

A

Painful and regular

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26
Q

True labour contractions occur under the influence of which hormone?

A

Oxytocin

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27
Q

During the active phase of the first stage of labour, how often are women offered a vaginal examination?

A

Every 4 hours

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28
Q

A dilatation of how many centimetres per hour suggests normal progress in the active phase of the first stage of labour?

A

1-2cm

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29
Q

What is the minimum dilation required to state that adequate progress is being made in the active phase of the first stage of labour?

A

2cm every 4 hours

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30
Q

Are women advised to eat and drink during the active phase of the first stage of labour?

A

Yes

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31
Q

Describe when the second stage of labour would be considered prolonged in a nulliparous woman?

A

Lasting > 2 hours without regional anaesthesia or > 3 hours with regional anaesthesia

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32
Q

Describe when the second stage of labour would be considered prolonged in a multiparous woman?

A

Lasting > 1 hour without regional anaesthesia or > 2 hours with regional anaesthesia

33
Q

A prolonged second stage of labour increases the risk of what complications?

A

PPH and maternal infection

34
Q

What are the three main elements of active management of the third stage of labour?

A

Uterotonic drugs, controlled cord traction and cord clamping

35
Q

Providing there is no immediate risk to the life of the mother or newborn, cord clamping should be delayed for how long?

A

3 minutes, or until pulsation ceases

36
Q

What are some signs of placental separation, which would suggest that it is the appropriate time to begin active management of the third stage of labour?

A

Sudden gush of blood and lengthening of the umbilical cord

37
Q

What is Syntometrine?

A

5IU of oxytocin with 500mcg of ergometrine

38
Q

How can oxytocin be given in the active management of the third stage of labour?

A

It is given IM- either as 10IU alone, or as Syntometrine

39
Q

Both oxytocin alone and as Syntometrine are equally effective at preventing haemorrhage > 1000ml. Which is better at preventing smaller haemorrhages, but comes with a risk of nausea and vomiting?

A

Syntometrine

40
Q

What is the reason for active management of the third stage of labour?

A

To reduce the risk of PPH

41
Q

What is the average duration of the third stage of labour?

A

10 minutes

42
Q

Describe what would be considered as a normal duration of the third stage of labour, with both expectant and active management?

A

30 minutes with active management, 1 hour with expectant management

43
Q

What is the current recommendation for skin-skin contact after delivery?

A

1 hour of uninterrupted skin to skin following delivery

44
Q

What is a normal amount of blood to lose during labour?

A

< 500mls

45
Q

How is the foetal heart rate monitored during labour in low risk pregnancies?

A

Intermittent auscultation

46
Q

How is the foetal heart rate monitored during labour in high risk pregnancies?

A

CTG

47
Q

How often must intermittent auscultation be performed in the active phase of the first stage of labour?

A

For 1 minute immediately after a contraction, and at least every 15 minutes

48
Q

How often must intermittent auscultation be performed in the second stage of labour?

A

For 1 minute immediately after a contraction, and at least every 5 minutes

49
Q

What would be considered a normal baseline rate on CTG?

A

100-160 bpm

50
Q

What would be considered a normal baseline variability on CTG?

A

5-25 bpm

51
Q

What is an acceleration on a CTG?

A

An increase in heart rate > 15bpm for > 15 seconds

52
Q

When should accelerations on a CTG generally occur?

A

Alongside the uterine contractions

53
Q

Is an acceleration on a CTG normal?

A

Yes

54
Q

What is a deceleration on a CTG?

A

A decrease in foetal heart rate of > 15bpm for > 15 seconds

55
Q

Early decelerations on a CTG are considered to be normal. When do these occur?

A

They start at the beginning of a contraction and recover when they contraction stops

56
Q

An abnormal CTG is an indication for what management?

A

Immediate delivery

57
Q

A late deceleration on CTG begins at the peak of a uterine contraction and recovers after the contraction ends. This is a sign of what?

A

Foetal distress

58
Q

A variable deceleration on CTG is a rapid fall in baseline foetal heart rate with a variable recovery phase and no relation to uterine contractions. This can be a sign of what complication?

A

Cord compression

59
Q

What are some complications of Entonox use, which resolve upon stopping it?

A

Light headedness and nausea

60
Q

How are opioids given as pain relief in labour?

A

IM

61
Q

At what birthing site would opioid analgesia be contraindicated?

A

Pool delivery

62
Q

What other medication must always be given alongside opioids for analgesia in labour?

A

Anti-emetic

63
Q

What are some potential complications of using opioids for pain relief in labour?

A

Maternal and foetal drowsiness and respiratory depression

64
Q

Where would the catheter be inserted into for giving an epidural or spinal anaesthetic?

A

L3/4

65
Q

What medication is injected in both epidural and spinal anaesthesia?

A

Opioid and local anaesthetic

66
Q

What monitoring is required in women who are using epidural or spinal anaesthesia in labour?

A

CTG and blood pressure monitoring

67
Q

What scoring system is used to determine whether or not to induce labour? What score would suggest that labour is unlikely to start on its own without induction?

A

Bishop’s score, < 5

68
Q

What method of induction of labour is offered to women at antenatal visits from 40 weeks?

A

Membrane sweep

69
Q

What medical management is first line for induction of labour?

A

Synthetic prostaglandins

70
Q

What is the main complication of the use of synthetic prostaglandins when inducing labour? How can this be resolved?

A

Uterine hyperstimulation- use tocolytic drugs e.g. terbutaline

71
Q

When may vaginal prostaglandins be contraindicated as a method of induction of labour? In these cases, what method should be used instead?

A

If the woman has had a previous C-section- use artificial rupture of membranes instead

72
Q

What defines the puerperium?

A

The 6 week period following delivery

73
Q

What is the general name for discharge which occurs in the puerperium?

A

Lochia

74
Q

How soon after delivery should the fundal height return to a pelvic level? If this does not occur, what complication may this be a sign of?

A

Within 2 weeks; if this does not occur it could be a sign of retained products and infection

75
Q

In non-breastfeeding women, when does menstruation usually occur following delivery?

A

8 weeks

76
Q

When do midwife visits occur after delivery?

A

Day 1, 5 and 10

77
Q

What additional test is carried out by the midwife on day 5 following delivery?

A

Neonatal screening

78
Q

How soon after delivery should a check up be carried out by the GP?

A

6-8 weeks

79
Q

Breastfeeding women can use all forms of contraception except for what?

A

The combined oral contraceptive pill

Obs & Gynae (Obs) (10 decks)

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