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FINALS - OBS, GYNAE, BREAST > normal labour > Flashcards

normal labour Flashcards

1
Q

function PGE labour

A

increase contractions

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2
Q

function oxytocin labour

A

increase contractions, excitability + PGE production

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3
Q

cervical changes labour

A

cervical softening (increased hyaluniric acid) // cervical ripening (decreased collagen)

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4
Q

monitoring in labour

A

FHR CTG // contractions 30 mins // pulse 60 mins // BP, temp, ketones and proteins 4 hours

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5
Q

3 Ps of labour

A

power (contrications), passage (shape of pelvis), passenger (feotal lie and presentation)

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6
Q

normal presenting fetus

A

cephalic lie, occipit-anterior // flexed head

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7
Q

what are braxton hicks contractions

A

3rd trimester, irregular and painless ‘contractions’

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8
Q

what are the 3 stages of labour

A

1 = until fully dilates // 2 = passage of baby / 3 = delivery of placenta

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9
Q

stage 1 labour latent phase + rate

A

0-3cm (takes about 6 hours)

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10
Q

stage 1 labour active phase + rate

A

3cm to fully dilated (1cm/hr)

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11
Q

how long should stage 1 take in primigravida mums

A

10-16 hours

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12
Q

usual presentation of fetus in stage 1

A

vertex (head enters pelvis in occipito-lateral)

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13
Q

what is passive second stage

A

abscence of pushing

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14
Q

what is active second stage

A

active process of maternal pushing (less painful than 1st stage)

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15
Q

when is stage 2 too long in nullparous women

A

> 2 hours (>3 in epidural)

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16
Q

when is stage 2 too long in multiparous women

A

> 1 hour (2> in epidural)

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17
Q

what are the 7 cardinal movements of labour

A

1) engagement (baby head tranverse in pelvis) –> 2) descent (baby through birth canal) –> 3) flexion –> 4) internal rotation (now AP) –> 5) crowning and extension –> 6) retitution and external rotation –> 7) expulsion

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18
Q

how long does stage 3 of labour last

A

5-10 mins (up to half an hour)

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19
Q

signs stage 3 is complete

A

uterus hardens and risens // umbilical cord lengthens // gush of blood

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20
Q

benefits of delayed cord clamping

A

more haemoglobin and blood volume to baby

21
Q

how is a CTG read

A

DR C BRAVADO (risk , contractions, rate, accelerations, decelerations, overall)

22
Q

normal foetal heart rate

A

100-160

23
Q

causes foetal bradycardia

A

fetal vagal tone // maternal BB

24
Q

causes foetal bradycardia

A

pyrexia, infection, hypoxia, prematura

25
Q

how many contractions should be in 10 mintes

A

3-4 // too few = not progressing // too many = hyperstimulation

26
Q

normal baseline variabilities CTG

A

5-15

27
Q

causes loss of variability

A

premature, hypoxia, epidural, sleeping baby (worry if >90mins)

28
Q

accelerations in a CTG

A

increase in heart rate >15bmp for >15 seconds after each contraction

29
Q

what is an early deceleration

A

reduced heart rate that coincides with start of contraction and goes back to normal once contraction finishes (usually not harmful)

30
Q

what is a late decel CTG

A

a deceleration of HR that lags behind start of contraction and takes 30 seconds to fix itself (sign of ditress)

31
Q

what are variable decels

A

independent of contractions (cord compression)

32
Q

indications for IOL

A

prolonged pregnancy (1-2 weeks past date) // PPROM // diabetes, pre-eclampsia, cholestasis // intrauterine death

33
Q

what is bishops score

A

asses need for induction

34
Q

components of bishops score

A

position // consistency // effacement // dilation // station

35
Q

what bishop score indicates need for inducing labour

A

<5

36
Q

what bishop score indicates spontaneous labour

A

> 8

37
Q

1st method for IOL

A

membrane sweep (informal method, can be done by midwife)

38
Q

medications used for IOL

A

vaginal PGE2, oral PGE1 (misoprotsol), oxytonin

39
Q

procedural methods IOL

A

amniotomy (break waters) // cervical ripening balloon

40
Q

what bishops score indicates medical method for IOL

A

<6 = vaginal PGE or oral misoprotsol

41
Q

what bishops score indicates procedural method for IOL

A

> 6 = amniotomy or IV oxytocin

42
Q

biggest complication IOL

A

uterine hyperstimulation

43
Q

symptoms of uterine hyperstimulation

A

fetal hypoxia or acidaemia // uterine rupture

44
Q

mx uterine hyperstimulation

A

remove vaginal PGE, stop oxytocin

45
Q

non-medical mx for pain in labour

A

TENS or etenox (50% NO + 50% air)

46
Q

opiates used in labour

A

Pethidine or diamorphine (may cause neonatal distress)

47
Q

where is an epidural inserted + what meds are administered

A

L3-4 // Levobupivacaine/ bupivacaine + fentanyl

48
Q

risks epidural

A

slow labour, fetal bradycardia + distress // maternal hypotension, headache, atonic bladder

49
Q

analgesia for c section

A

spinal - LA + opioid to subarachnoid space

FINALS - OBS, GYNAE, BREAST (27 decks)

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